title: Risk factors associated with the death of patients hospitalized for juvenile systemic lupus erythematosus.
abstract: We assessed the risk factors associated with death in patients hospitalized for juvenile systemic lupus erythematosus (JSLE) and evaluated the autopsy reports. A total of 57,159 hospitalizations occurred in our institution from 1994 to 2003, 169 of them involving 71 patients with JSLE. The most recent hospitalization of these patients was evaluated. Patients were divided into two groups based on mortality during hospitalization: those who survived (N = 53) and those who died (N = 18). The main causes of hospitalization were JSLE activity associated with infection in 52% and isolated JSLE activity in 44%. Univariate analysis showed that a greater risk of death was due to severe sepsis (OR = 17.8, CI = 4.5-70.9), systemic lupus erythematosus disease activity index (SLEDAI) >or=8 (OR = 7.6, CI = 1.1-53.8), general infections (OR = 6.1, CI = 1.5-25), fungal infections (OR = 5.4, CI = 3.2-9), acute renal failure (OR = 5.1, CI = 2.5-10.4), acute thrombocytopenia (OR = 3.9, CI = 1.9-8.4), and bacterial infections (OR = 2.3, CI = 1.2-7.5). Stratified analysis showed that severe sepsis and SLEDAI >or=8 were not confounder variables. In the multivariate analysis, logistic regression showed that the only independent variable in death prediction was severe sepsis (OR = 98, CI = 16.3-586.2). Discordance between clinical diagnosis and autopsy was observed in 6/10 cases. Mortality of hospitalized JSLE patients was associated with severe sepsis. Autopsy was important to determine events not detected or doubtful in dead patients and should always be requested.
authors.affiliation: Unidades de Reumatologia e Infectologia Pediátricas, Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: M M M
authors.initials: MM
authors.lastname: Faco
authors.forename: C
authors.initials: C
authors.lastname: Leone
authors.forename: L M A
authors.initials: LM
authors.lastname: Campos
authors.forename: M V
authors.initials: MV
authors.lastname: Febrônio
authors.forename: H H S
authors.initials: HH
authors.lastname: Marques
authors.forename: C A
authors.initials: CA
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000401:mortality*; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index