Risk factors for mortality in systemic lupus erythematosus patients: Analysis of adult and pediatric cohorts in Taiwan

Sep 29, 2026

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Systemic lupus erythematosus (SLE) survival has improved in recent decades, yet mortality risk remains elevated, and long-term outcomes in pediatric patients are not well established. This retrospective, hospital-based cohort study (2004–2018, Taiwan) evaluates long-term survival rates and identifies predictors of mortality using time-dependent multivariate Cox proportional hazards models and clinical risk-factor data.

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CategoryHealthcare

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J Chin MedAssoc Original article Risk factors for mortality in systemic lupus erythematosus patients: Analysis of adult and pediatric cohorts in Taiwan Chien-Chih Laia,b,c, Yi-Syuan Suna,b,c, Wei-Sheng Chena,b,c, Hsien-Tzung Liaoa,c, Ming-Han Chena,c, Chang-Youh Tsaia,c,d, De-Feng Huanga, Chung-Tei Choua, Deh-Ming Changa,b,e,f,* aDivision of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC cFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDivision of Immunology and Rheumatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, ROC; eGraduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; fGraduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC Abstract Background: Overall survival of systemic lupus erythematosus (SLE) patients significantly increased in recent decades, however, the relative risk of mortality is still high. Long-term survival outcome of pediatric SLE remains unclear. This study aims to explore the long-term survival rate and its predictors in patients with systemic lupus erythematosus (SLE) . Methods: A retrospective, hospital-based cohort study was performed between 2004 and 2018 in a tertiary referral medical center in Taiwan. Data on comorbidities, medications, and causes of admission were collected for risk factor analysis using timedependent multivariate Cox proportional hazards models. Results: A total of 2392 adults and 115 pediatric SLE patients were enrolled (female, n = 2157 and 95, respectively) . The 10-year survival rates were 93.2%, 90.2%, 98.9%, and 100% in adult women, adult men, girls, and boys with SLE, respectively. The overall mortality rate was 2.09 case/100 patient-years (PY) for male SLE and 1.39 case/100 PY for female SLE patients. Male SLE patients did not have a statistically significantly higher mortality rate than female SLE patients in each age stratification. Infectious disease (n = 119), heart failure (n = 21), and cerebrovascular accident (n = 14) were the leading causes of death in adult SLE patients. Advanced age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.03-1.05), treatment with mean dosage of systemic glucocorticoid equivalent to >10mg/d of prednisolone (HR: 1.71, 95% CI: 1.14-2.57), comorbidities with malignancy (HR: 1.94, 95% CI: 1.22-3.09), chronic kidney disease (HR: 1.86, 95% CI: 1.25-2.77), hypertension (HR: 1.42, 95% CI: 1.01-1.98), and admission due to bacterial pneumonia (HR: 1.92, 95% CI: 1.12-3.31) and sepsis (HR: 2.78, 95% CI: 1.51-5. 13) were independent risk factors for mortality in SLE patients. Conclusion: SLE patients with advanced age, malignancy, chronic kidney disease, hypertension, treated with a higher average dosage of glucocorticoids, and admission due to bacterial pneumonia and sepsis have an increased risk of mortality. Keywords: Chronic kidney disease; Glucocorticoid; Hypertension; Malignancy; Mortality; Risk factor; Sepsis; Systemic lupus erythematosus 1. INTRODUCTION Systemic lupus erythematosus (SLE) is a disease characterized by immune disorders that involves multiple organs and systems *Address correspondence. Dr. Deh-Ming Chang, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: ming0503@ms3.hinet.net (D.-M. Chang). Conflicts of interest: Dr. Chang-Youh Tsai and Dr. Deh-Ming Chang, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of C

FAQs

What is the study’s primary purpose?

To determine long-term survival rates and identify predictors of mortality in systemic lupus erythematosus (SLE) patients, including both adult and pediatric cohorts.

How was the study conducted?

A retrospective hospital-based cohort study was performed in Taiwan between 2004 and 2018, using time-dependent multivariate Cox proportional hazards models for risk-factor analysis.

Which factors were identified as independent risk factors for mortality?

Advanced age, higher average systemic glucocorticoid dosage, malignancy, chronic kidney disease, hypertension, and admission due to bacterial pneumonia and sepsis were independently associated with increased mortality risk.

Sep 29, 2026

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