Document Detail


Renal damage is the most important predictor of mortality within the damage index: data from LUMINA LXIV, a multiethnic US cohort.
MedLine Citation:
PMID:  19233884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Damage accrual in SLE has been previously shown to be an independent predictor of mortality. We sought to discern which SLICC Damage Index (SDI) domains are the most important predictors of survival in SLE. METHODS: SLE patients (ACR criteria), age > or =16 years, disease duration < or =5 years at enrolment, of African-American, Hispanic or Caucasian ethnicity were studied. Disease activity was assessed using the SLAM-Revised (SLAM-R) at diagnosis. Damage was ascertained using the SDI at the last visit. The SDI domains associated with time to death (and interaction terms) were examined by univariable and multivariable Cox proportional hazards regression analyses; those significant in the multivariable analyses were added to the final two models (with and without poverty) that included other variables known to be associated with shorter survival. RESULTS: A total of 635 SLE patients were studied of whom 97 (15.3%) have died over a mean (s.d.) total disease duration of 5.7 (3.7) years. Patients were predominantly women [570 (89.8%)]; their mean (s.d.) age was 36.5 (12.6) years; 126 (19.8%) had developed renal damage, 62 (9.3%) cardiovascular, 48 (7.8%) pulmonary and 34 (5.4%) peripheral vascular damage. When excluding poverty from the multivariable model, the renal domain of the SDI was independently associated with a shorter time to death (hazard ratio = 1.65; 95% CI 1.03, 2.66). CONCLUSIONS: The renal domain of the damage index is associated with a shorter time to death when poverty, a strong predictor of this outcome, is removed from the model. Preventing renal damage in lupus patients has long-term prognostic implications.
Authors:
Maria I Danila; Guillermo J Pons-Estel; Jie Zhang; Luis M Vilá; John D Reveille; Graciela S Alarcón
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-02-20
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  48     ISSN:  1462-0332     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-17     Completed Date:  2009-06-18     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  542-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
African Americans / statistics & numerical data
Aged
Epidemiologic Methods
Female
Hispanic Americans / statistics & numerical data
Humans
Lupus Erythematosus, Systemic / ethnology,  mortality
Lupus Nephritis / ethnology,  mortality*
Male
Middle Aged
Poverty / statistics & numerical data
Prognosis
Puerto Rico / epidemiology
Sex Factors
Texas / epidemiology
Young Adult
Grant Support
ID/Acronym/Agency:
1P20RR11126/RR/NCRR NIH HHS; M01-RR00032/RR/NCRR NIH HHS; M01-RR02558/RR/NCRR NIH HHS; P01 AR49084/AR/NIAMS NIH HHS
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