Pediatric Rheumatology Online Journal → July 2003 → Childhood Lupus→ Clinical Presentation, course and Outcomes → Abstract #99

DEATH IN PATIENTS HOSPITALIZED WITH JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS (JSLE)

C. A. Silva,¹ M. M. Faco,¹ C. Leone,² B. L. Liphaus,¹ L. M. Campos.¹

¹Department of Pediatric - Pediatric Rheumatology Unit, Instituto da Crianca - Hospital das Clinicas, Sao Paulo, SP, Brazil; ²Department of Pediatric, Instituto da Crianca - Hospital das Clinicas, Sao Paulo, SP, Brazil

Objective: To assess hospitalization due to JSLE in our Pediatric Rheumatology Service and identify risk factors of death.
Patients and methods: 399 hospitalizations of patients with pediatric rheumatic diseases occurred from 1994 to 2002 in our Service (mean of 3.7 hospitalizations per month). 136 of them suffered from JSLE (64 patients) and were under observation. All of them met the criteria of the ACR for JSLE. The demographic data, clinical features, patterns of disease activity, SLICC/ACR Damage Index, SLEDAI, laboratory and treatment during hospitalization were determined. Subsequently, patients were divided into two groups based on the death rate during hospitalization: group A (survived) and group B (died). Statistical analysis was carried out with Fisher and Mann-Whitney tests.
Results: The hospitalization occurred predominantly from July to September. Group A consisted of 53 patients and group B of 11. Comparison of the two groups revealed no difference in mean months of age of disease onset, mean months of disease duration, mean months of age of last hospitalization and mean of number of hospitalizations. The death was not correlated with gender male, arterial hypertension, nephritis (WHO III, IV or V), proteinuria greater than 0.5 g/day, presence of antibody to dsDNA, SLICC/ACR Damage Index greater than 1, chronic active disease and treatment with cyclophosphamide. The greater risk of death was demonstrated with: hospital acquired septicemia (relative risk (RR)=14.7, p=0.0001), hospitalization in intensive care unit (RR=14.7, p=0.0001), acute renal insufficiency (RR=8.4, p=0.0001), acute trombocytopenia (RR=2.6, p=0.0001) and SLEDAI greater than 8 (p=0.0115).
Conclusions: The patients with JSLE who died presented demographic data of the disease similar to the patients that survived. The presence of acute renal insufficiency, acute thrombocytopenia, septicemia, SLEDAI greater than 8 and hospitalization in ICU demonstrated greater risk of death.