Causes and predictors of death in South Africans with
systemic lupus erythematosus
, M. Tikly
and M. Hopley
Little is known about the long-term outcome and mortality patterns in systemic lupus erythematosus (SLE) in sub-Saharan
Africa. We undertook a retrospective study of SLE in mainly black, unemployed patients, seen at a tertiary institution in Soweto, South Africa,
to determine the causes and predictors of death.
Demographic, clinical and laboratory data and outcome were extracted from the case records of patients attending the Lupus Clinic
at Chris Hani Baragwanath Hospital.
Of the 270 case records with a diagnosis of SLE, 226 met the American College of Rheumatology classification criteria for SLE.
The female to male ratio was 18 : 1. The mean (
.) age at presentation was 34 (12.5) yrs. Arthritis, nephritis and neuropsychiatric disease
had a cumulative frequency of 70.4, 43.8 and 15.9% of patients, respectively. During the course of a mean follow-up period of 54.9 months,
193 (85.3%) and 89 (39.3%) patients were treated with oral corticosteroids and immunosuppressive agents, respectively. There were
55 (24.5%) known deaths and 64 (28.6%) patients were lost to follow-up. The estimated 5 yr survival rates were between 57 and 72%,
depending on whether the group of patients lost to follow-up was classified in the analysis as either alive or dead. Infection (32.7%) was the
commonest cause of death followed by renal failure (16.4%). Univariate analysis revealed that nephritis, neuropsychiatric disease and
hypocomplementaemia were associated with an increased mortality, but multivariate analysis showed nephritis as the only significant
predictor of mortality.
Our findings suggest that SLE in indigent South Africans not only carries a poorer prognosis but also the main cause of death,
infection and renal failure differ from those reported recently in industrialized Western countries. Nephritis is common in our patients and is the
only independent predictor of poor outcome.
Lupus, Mortality, Africa, Blacks.
Systemic lupus erythematosus (SLE) is a chronic multisystem
autoimmune disorder that has a predilection for young women.
Advances in the early serological detection of antinuclear
antibodies coupled with discovery of a variety of immunosup-
pressive agents, including corticosteroids, have had a major
positive impact on the outcome of the disease over the last
50 years . In addition, progress in several other areas of clinical
medicine, including diagnostic imaging, intensive care services,
dialysis and transplantation and antimicrobial agents, have
contributed to the reduction and mortality associated with SLE
[2, 3]. Since the mid-1990s, several centres from the industrialized
world have reported 5-yr survival rates in excess of 90% [4–7],
compared with an appalling 40% in 1956 . Notwithstanding
these achievements, standardized mortality rates for SLE exceed