Introduction:

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by chronic systemic inflammation. Causes of death in SLE have a bimodal pattern: during the first 5 years, infections and disease activity prevail, whereas beyond 5 years cardiovascular complications and accumulated organ damage are the main causes.

Objective: To determine causes of death in adult patients diagnosed with SLE admitted to the Department of Internal Medicine of the National Hospital from January 2010 to December 2018.

Materials and methods:

Retrospective, observational, descriptive, cross sectional study of adult patients admitted to the Department of Internal Medicine and the Emergency Department of the National Hospital of Itaugúa, from 2010 to 2018. Out of 585 patients with SLE admitted during this period, 63 died. 25 patients were included and 38 were excluded due to incomplete studies. SLE diagnosis was made according to SLICC criteria. The variables analyzed were demographic, clinical, laboratory, causes of death, mortality. Data was analyzed with descriptive statistics. Frequencies and proportions were used for qualitative variables, means and standard deviation for continuous variables.

Results:

25 patients were included, 18 were women (72%) and 7 were men (28%). Mean age was 30±15.5 (18-77). 40% (n=10) came from Central Department and 60% (n=15) were from the countryside. 70.8% of the patients had a disease duration between 2 and 5 years (n=18). 92% had been previously diagnosed with SLE. Regarding disease activity, patients presented with nephritis (76%), alveolar hemorrhage (12%), pneumonitis (4%), neurolupus (4%) and CNS vasculitis (4%). On the subject of infections, the following were found: nosocomial pneumonia (45%), community acquired pneumonia (8%), strongyloides hyperinfection (4%), disseminated cryptococcosis (4%). The main causes of death were infections (44%), followed by disease activity (36%) and causes not related to SLE (20%; severe mitral and aortic insufficiency, acute pulmonary edema secondary to chronic kidney disease as complication of lupus nephritis, hemorrhagic stroke). 100% received corticosteroids and 60% immunosuppressants.

Conclusion:

Mortality was 10.8%, the main causes of death were infections followed by disease activity.

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