Mortality and Multiple Causes of Death in Systemic Lupus Erythematosus - Role of the Death Certificate Academic Article uri icon


  • Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with a wide range of laboratory and clinical features. It is characterized by a remitting recurring course. Although mild in severity in a significant number of patients, SLE can be severe and refractory to therapy in others and is associated with mortality rates higher than that of the general population. Mortality and prognosis studies among patients with SLE have been investigated in patients referred to tertiary lupus clinics and in well defined epidemiological settings. Those studies have addressed one or more aspects of mortality and survival in SLE, including annual mortality rates, causes of death, survival rates and curves, standardized mortality ratios (SMR), and predictors associated with early and late death. The development of various valid and reproducible outcome measures in SLE has been a major step in the detecting of variables associated with morbidity and mortality in these patients. In addition, measures of SLE disease activity, permanent damage, quality of life, and other variables enable comparisons between prognostic studies from various centers1. A review of the literature identified more than 60 large prognostic and mortality studies in SLE reported from different lupus clinics around the globe. Most studies have suggested improved survival of patients with SLE. Prognosis studies from the University of Toronto Lupus Clinic have shown that over 4 decades, the SMR has decreased from 12.6 in the first decades to 3.46 in the last decade. When SMR were stratified by entry cohort and calendar period, there was evidence of a calendar-period effect, but no cohort effect. Various disease-related variables were significantly associated with mortality but could not completely explain the trend of improved survival over calendar period observed2. Causes of death in SLE are classified into those related to SLE, those resulting from … Address correspondence to Dr. Abu-Shakra; E-mail: Mahmoud{at}

publication date

  • January 1, 2012