Patient-Reported Outcomes Predict Mortality in Systemic Lupus Erythematosus

In individuals with systemic lupus erythematosus (SLE), patient-reported outcomes (PROs) are independent predictors of mortality after accounting for demographics and disease, according to the results of a large prospective study published in Arthritis Care & Research.

The investigators sought to evaluate whether PROs, including the Medical Outcomes Study Short Form 36 (SF-36), predict mortality in patients with SLE. Their analysis utilized a large community-based sample and accounted for other known covariates linked to mortality in individuals with SLE.

Data derived from the University of California San Francisco Lupus Outcomes Study were obtained mainly from primary annual structured telephone interviews in which symptoms, medications, and other treatments were queried. A number of validated PROs (SF-36 subscales), self-rated health, and depression measured with the Center for Epidemiologic Studies Depression (CESD) scale were used to predict mortality.

At baseline, there was a total of 728 participants. Mean patient age was 50.6±12.6 years, 92.2% of participants were women, and 68.5% were white. Overall, the mean duration of SLE was 16.7 years and 11% of participants reported below-poverty income.

A total of 71 deaths were reported. According to univariate analysis, both the SF-36 physical component score and self-rated health were associated with mortality, but the SF-36 mental health subscale and the CESD were not. In multivariate analyses, lower SF-36 physical function scores at baseline independently predicted mortality after controlling for all other covariates (hazard ratio, 0.97; 95% CI, 0.94-0.99; P <.01).

The investigators concluded that patient-reported physical function was an independent predictor of mortality in patients with SLE, even after accounting for demographics and disease. Since PROs are easy to evaluate, they may be useful to triage, track, and guide early interventions in patients with SLE who are at high risk for morality. This is only the second large observational study to investigate the relationship between PROs and mortality in patients with SLE and the first study to report a longitudinal relationship between PROs and mortality in patients with SLE, as observed in individuals with other chronic diseases.

Future research should explore the specific aspects of physical functioning that are predictive of mortality in this patient population and the effect of providing interventions that aim to improve physical function, potentially resulting in enhanced outcomes and reduced mortality rates.

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Reference

Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Patient reported outcomes predict mortality in lupus [published online August 24, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23734