title: The association between initial manifestations of childhood-onset systemic lupus erythematosus and the survival.
abstract: BACKGROUND
  Childhood-onset systemic lupus erythematosus (cSLE) comprises 15-20% of patients with SLE. Although several studies have reported the outcomes of adult-onset SLE, few investigations have been conducted on cSLE in the Middle East.
  
  
  METHODS
  In a retrospective study, all children with SLE admitted to our tertiary referral center between 1992 and 2011 were recruited. The clinical and laboratory data at the time of onset were recorded and analyzed. Kaplan-Meier analysis was used to calculate the survival rates. Cox regression analysis was applied to assess the predictors of mortality.
  
  
  RESULTS
  One hundred and eighty-eight children diagnosed with SLE were enrolled during the study period. Nine patients were censored due to loss to follow-up (6) and incomplete data (3 cases). Mean age of patients at the time of onset was 14.4 (3.05) years. Only 22 (11.8%) children were younger than 10 years at the time of disease onset. In total, 20 patients (11%) died, all after the first decade of life. The most common cause of death was lupus nephritis (10 patients, 50% of deaths) followed by infections (35%), cerebrovascular accidents (10%) and alveolar hemorrhage (5%). Cumulative survival rate after 5, 10, 15 and 20 years was 91, 87, 85, and 79%, respectively. Having hematuria or pleurisy at the time of SLE onset had a negative effect on survival in multivariate analysis.
  
  
  CONCLUSIONS
  cSLE survival in Iran was comparable to that in other developing countries. Baseline presentation with hematuria predominantly increased the mortality rate in cSLE. Prospective and larger studies in future may unfold other aspects of cSLE.
authors.affiliation: Department of Rheumatology, Alzahra Hospital, Isfahan, Iran. a_fatemi@med.mui.ac.ir.
authors.forename: Alimohammad
authors.initials: A
authors.lastname: Fatemi
authors.affiliation: Department of Internal Medicine, Alzahra Hospital, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Matinfar
authors.affiliation: Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Saber
authors.affiliation: Department of Epidemiology, School of Public Health, Indiana University, Bloomington, Indiana, USA.
authors.forename: Abbas
authors.initials: A
authors.lastname: Smiley
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002423:Cause of Death; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006417:Hematuria / Q000209:etiology / Q000401:mortality; D006801:Humans; D007492:Iran / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: childhood-onset; survival; systemic lupus erythematosus