title: Morbidity, mortality, and organ damage in patients with antiphospholipid syndrome.
abstract: OBJECTIVE
  To describe morbidity, organ damage, mortality, and cause of death in patients with antiphospholipid syndrome (APS).
  
  
  METHODS
  Descriptive analysis of 135 patients. Patients were clustered according to initial event: arterial thrombosis including stroke (AT; n = 46), venous thrombosis including pulmonary emboli (VT; n = 53), or pregnancy morbidity (PM; n = 36). Disease progression according to initial event and prevalence of organ damage was observed.
  
  
  RESULTS
  APS occurs among young individuals (mean age 33.3 ± 11.9 yrs). One-third of the patients have APS secondary to systemic lupus erythematosus (SLE) or SLE-like disease. A broad spectrum of clinical manifestations mark the disease onset even before diagnosis. The pattern of initial presentation is preserved with regard to second event; VT is followed by VT (84%), AT is followed by AT (95%), and PM is followed by PM (88.9%). The highest morbidity is attributed to neurologic damage. PM is more likely to be followed by a second event, yet is associated with less organ damage than AT and VT. After a mean followup of 7.55 years, 29% of patients experienced organ damage and 5 died, with Systemic Lupus International Collaborating Clinics score associated with increased mortality (HR 1.31, 95% CI 1.07-1.60, p = 0.01, per 1-unit increase); hematological malignancies occurred in 2 patients after a cumulative followup of 1020 person-years. Coexistent SLE adds significant damage in patients with APS.
  
  
  CONCLUSIONS
  APS is a disease of young individuals, who experience increased morbidity. Neurologic damage is the most common cause of morbidity. AT at presentation as well as coexistent SLE are associated with poor outcome.
authors.affiliation: Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece.
authors.forename: Eleftheria P
authors.initials: EP
authors.lastname: Grika
authors.forename: Panayiotis D
authors.initials: PD
authors.lastname: Ziakas
authors.forename: Elias
authors.initials: E
authors.lastname: Zintzaras
authors.forename: Haralampos M
authors.initials: HM
authors.lastname: Moutsopoulos
authors.forename: Panayiotis G
authors.initials: PG
authors.lastname: Vlachoyiannopoulos
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011655:Pulmonary Embolism / Q000453:epidemiology; D015996:Survival Rate; D013927:Thrombosis / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology