Elevation of inflammatory markers in patients with systemic lupus erythematosus is associated with poorer outcome

Objective: To determine the association between inflammatory markers and mortality in patients with systemic lupus erythematosus (SLE). Methods: A retrospective cohort analysis of 143 patients with SLE followed between 1991 and 2010 in a Lupus Clinic in Israel. High sensitivity CRP (hsCRP) level and ESR were recorded at baseline. We compared outcomes of patients with elevation of either ESR or hsCRP to outcomes of patients without any elevation of inflammatory markers at start of follow-up. Risk factors for mortality were identified using univariate and multivariate analyses (Cox regression analysis). Results: Of the 143 patients, 93 patients had an inflammatory marker and 50 had no inflammatory marker. There were no differences between the two groups in terms of lupus criteria, disease activity parameters or damage index. Survival was lower for patients in the inflammatory group, 24 deaths of 93 patients (25.8%), 1393 patients-years, versus five deaths of 50 patients (10%), 692 patient-years, in the non-inflammatory group, log rank P= 0.031. On multivariate analysis, inflammatory markers at baseline remained an independent risk factor for death, hazard ratio 2.72 (95% CI, 1.3-7.2). Conclusions: SLE patients with elevation of inflammatory markers at baseline are at higher risk of death.