Association Between Organ Damage and Mortality in Systemic Lupus Erythematosus: a Systematic Review and Meta-analysis

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 May 24

PMID 32444429

Citations 29

Authors

Irene B Murimi-Worstell

Dora H Lin

Henk Nab

Hong J Kan

Oluwadamilola Onasanya

Jonothan C Tierce

Xia Wang

Barnabas Desta

G Caleb Alexander

Edward R Hammond

Affiliations

Soon will be listed here.

Abstract

Objective: At least half of patients with systemic lupus erythematosus (SLE) develop organ damage as a consequence of autoimmune disease or long-term therapeutic steroid use. This study synthesised evidence on the association between organ damage and mortality in patients with SLE.

Design: Systematic review and meta-analysis.

Methods: Electronic searches were performed in PubMed, Embase, Cochrane Library and Latin American and Caribbean Health Sciences Literature for observational (cohort, case-control and cross-sectional) studies published between January 2000 and February 2017. Included studies reported HRs or ORs on the association between organ damage (measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score) and mortality. Study quality was assessed using the modified Newcastle-Ottawa assessment. Pooled HRs were obtained using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using the Cochrane Q (Q) and I statistics.

Results: The search yielded 10 420 articles, from which 21 longitudinal studies were selected. Most studies (85%) were of high quality. For 10 studies evaluating organ damage (SDI) as a continuous variable and reporting HR as a measure of association, a 1-unit increase in SDI was associated with increased mortality; pooled HR was 1.34 (95% CI: 1.24 to 1.44, p<0.001; Q p=0.027, I=52.1%). Exclusion of one potential outlying study reduced heterogeneity with minimal impact on pooled HR (1.33 (95% CI: 1.25 to 1.42), p<0.001, Q p=0.087, I=42.0%). The 11 remaining studies, although they could not be aggregated because of their varying patient populations and analyses, consistently demonstrated that greater SDI was associated with increased mortality.

Conclusions: Organ damage in SLE is consistently associated with increased mortality across studies from various countries. Modifying the disease course with effective therapies and steroid-sparing regimens may reduce organ damage, improve outcomes and decrease mortality for patients with SLE.

Citing Articles

Development and evaluation of a Register-Based Organ Damage Index in systemic lupus erythematosus: a nationwide, population-based study from Sweden.

Gomez A, Parodis I, Saleh M, Simard J, Sjowall C, Arkema E Lupus Sci Med. 2025; 12(1).

PMID: 40011068 PMC: 11865802. DOI: 10.1136/lupus-2024-001403.

Mortality patterns of SLE and the associated risk factors in Korean patients: a nationwide cohort study.

Cho S, Jeon Y, Kim J, Jang E, Jung S, Sung Y Lupus Sci Med. 2025; 12(1).

PMID: 40011067 PMC: 11865735. DOI: 10.1136/lupus-2024-001361.

Organ Damage and Its Associated Factors in Systemic Lupus Erythematosus Patients: A Retrospective Cohort Study.

Alharbi L, Al-Homood I, Binammar A, AlMuhareb N J Clin Med Res. 2025; 17(1):35-43.

PMID: 39866817 PMC: 11753984. DOI: 10.14740/jocmr6129.

Longitudinal associations of flare and damage accrual in patients with systemic lupus erythematosus.

Kandane-Rathnayake R, Milea D, Louthrenoo W, Hoi A, Golder V, Cho J Lupus Sci Med. 2025; 12(1.

PMID: 39832908 PMC: 11751792. DOI: 10.1136/lupus-2024-001363.

Efficacy of initial combination with belimumab in newly diagnosed childhood-onset lupus nephritis: a single-centre historical control study.

Gong Y, Liu S, Liu H, Shi Y, Li Y, Guan W Lupus Sci Med. 2024; 11(2).

PMID: 39675786 PMC: 11647295. DOI: 10.1136/lupus-2024-001350.

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