O. Rusinovich Lovgach1, Z. Plaza2, M. Fernandez Castro1, J. Rosas Gómez de Salazar3, V. Martinez Taboada4, O. Alejandro5, R. Menor-Almagro6, B. Serrano-Benavente7, J. Font-Urgelles8, Á. García-Aparicio9, S. Manrique-Arija10, J. A. García-Vadillo11, R. López-González12, F. J. Narváez Garcia, R. L. Beatriz13, C. Galisteo14, J. J. González Martin15, P. Vela Casasempere16, C. Bohórquez28, C. Erausquin17, M. B. Paredes-Romero18, L. Riancho-Zarrabeitia27, S. Melchor Diaz19, J. M. Pego-Reigosa, S. Heredia20, C. Moriano Morales21, M. Á. Blázquez22, P. Estrada23, E. Judez24, J. M. Belzunegui Otano25, C. Ramos Giráldez26, F. Sánchez-Alonso2, J. L. Andréu Sánchez1
1Puerta de Hierro Majadahonda University Hospital, Rheumatology, Madrid, Spain
2Spanish Society of Rheumatology, Research Unit, Madrid, Spain
3Marina Baixa de la Vila Joiosa Hospital, Rheumatology Department, Alicante, Spain
4Marqués de Valdecilla University Hospital, Rheumatology Department, Santander, Spain
5Germans Trías i Pujol Badalona University Hospital, Rheumatology Department, Barcelona, Spain
6General University Hospital Jerez de la Frontera, Rheumatology Department, Jerez de la Frontera, Spain
7University Hospital Gregorio Marañon, Rheumatology Department, Madrid, Spain
8Hospital Universitari Germans Trias i Pujol, Rheumatology Department, Badalona, Spain
9Toledo University Hospital, Rheumatology Department, Toledo, Spain
10Malaga Regional Hospital, Rheumatology Department, Malaga, Spain
11La Princesa University Hospital, Rheumatology Department, Madrid, Spain
12Zamora Health Complex, Rheumatology Department, Zamora, Spain
13Canarias University Hospital, Rheumatology Department, La laguna, Spain
14Hospital Parc Taulí, Rheumatology Department, Sabadel, Spain
15HM Sanchinarro University Hospital, Rheumatology Department, Madrid, Spain
16General University Hospital Dr. Balmis, Rheumatology Department, Alicante, Spain
17Dr Negrin University Hospital, Rheumatology Department, Las Palmas, Spain
18Infanta Sofía University Hospital, Rheumatology Department, San Sebastián de los Reyes, Spain
1912 de Octubre University Hospital, Rheumatology Department, Madrid, Spain
20Complex Hospitalari Moisès Broggi, Rheumatology Department, Barcelona, Spain
21León University Hospital, Rheumatology Department, Leon, Spain
22Ramon y Cajal University Hospital, Rheumatology Department, Madrid, Spain
23Complex Universitari Hospital Moisès Broggi, Rheumatology Department, Barcelona, Spain
24Albacete University Hospital, Rheumatology Department, Albacete, Spain
25Donostia University Hospital, Rheumatology Department, Donostia, Spain
26Valme University Hospital, Rheumatology Department, Seville, Spain
27Sierrallana Hospital, Rheumatology Department, Torrelavega, Spain
28Principe de Asturias University Hospital, Rheumatology Department, Alcala de Henares, Spain
Background: Sjögren’s Disease (SjD) is a chronic systemic autoimmune disease predominantly affecting exocrine glands, but with potential multisystem involvement. While significant advances have been made in understanding its pathophysiology and clinical spectrum, the impact of SjD on mortality remains a topic of active debate.
Objectives: The objective of our study was to determine the magnitude of all-cause risk of mortality in patients with SjD compared with the general population, analyze the causes, and identify predictive factors of mortality in SjD.
Methods: We analyzed data from SjögrenSER-PROS observational multicenter prospective cohort after 9 years of follow up. All patients included in the study fulfilled the 2002 American European Consensus Group classification criteria and participated in the cross-sectional phase of the study (SJÖGRENSER TRANS). Sociodemographic, clinical, and serological variables, comorbidities and treatments, as well as indicators of disease activity and organ damage were recorded. Continuous and categorical variables were analyzed using means, medians, and frequencies, with their respective deviations. Variables associated with mortality in univariate analysis were included in multivariate models to determine which ones were independently associated with the outcome of the disease. A linked registry study using information from our own registry combined with the Spanish Cause-of-Death Registry was performed and standardized mortality ratios (SMR) were calculated. Survival analysis was performed using Cox regression models to estimate which variables were associated with a greater mortality risk.
Results: A total of 314 patients were included (94.6% women) with an average age of 66 (± 11.45) and an average duration of the disease of 17 (±6,5) years. Over average of 9.6 [9.3-9.9] years of follow up 42 (13,4%) patients died. SMR was 1.7 CI 1.2-2.3. Infections (35,71%), cancer (23,8%), and cardiovascular disease (7,14%) de were the three leading causes of death. Higher disease activity, longer disease duration, lung involvement, hypertension, history of heart failure, peripheral arterial disease, osteoporosis, and osteoporotic fractures, the presence of antiphospholipid antibodies, hypocomplementemia C4, increased acute-phase reactants, the use of rituximab and bolus of corticosteroids (CS) were significantly associated with reduced survival in univariate analysis. See multivariable analysis of factor associated with mortality in table 1.
Variables
HR
95% CI
p
Female
0.5
0.18-1.37
0.178
Age
1.11
1.07-1.15
0, 001
Hypocomplementemia C4 (mg/dL)
3.75
1.55-9.06
0.003
ESR (mm/h)
1.01
1-1.03
0.047
History of heart failure
4.24
1-02-17.58
0.047
History of osteoporotic fracture
2.09
0.83-5.26
0.117
Lung involvement
3.31
1.39-7.88
0.007
NSAID
0.23
0.1-0.56
0.01
Rituximab
2.68
0.98-7.31
0.054
Conclusion: The existing data indicates 70% increase in mortality among patients with SjD compared with the general population. Older age, history of heart failure, hypocomplementemia C4, increase of ESR and lung involvement were independent risk factors associated with increased mortality. More attention should be paid to those patients with poor prognostic factors
REFERENCES: NIL.
Acknowledgements: Spanish Society of Rheumatology.
