MORTALITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A META-ANALYSIS OF OVERALL AND CAUSE-SPECIFIC EFFECTS
Bibliographic record
Abstract
PV236 / #46 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose While therapeutic advancements have markedly refined the management of systemic lupus erythematosus (SLE), SLE patients persistently face mortality rates significantly higher—by 2 to 5-fold—than the general population. Persistent concerns about mortality rates necessitate a thorough appraisal of mortality trends within this complex patient cohort. The objective of this study was to assess the overall and cause-specific standardized mortality ratios (SMRs) among patients with SLE. Methods An exhaustive systematic review was undertaken, encompassing studies that scrutinized SMRs, both overall and for specific causes, in patients diagnosed with SLE compared to the general populace. The databases of PUBMED, EMBASE, and Cochrane were meticulously searched to collate relevant literature. Following this comprehensive search, a meta-analysis was executed to methodically assess all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in patients with SLE. Results The inclusion criteria were met by 29 studies encompassing 72,342 patients with SLE and documenting 7,352 deaths. The meta-analysis disclosed a pronounced 2.87-fold elevation in the SMR for all-cause mortality in SLE patients relative to the general population (SMR, 2.866; 95% confidence interval [CI], 2.490-3.242; p < 0.001). Region-specific assessments showed variable all-cause SMRs, with Europe reporting 2.607 (95% CI, 1.939-3.275; p < 0.001), Asia revealing 3.043 (95% CI, 2.082-4.004; p < 0.001), and particularly high SMRs noted in North America and Oceania. Gender-focused analyses presented a pooled SMR of 3.261 (95% CI, 2.674-3.848; p < 0.001) for females, and 2.747 (95% CI, 2.190-3.304; p < 0.001) for males. Evaluations specific to cause of death illustrated notably elevated SMRs for renal disease (SMR, 4.486; 95% CI, 3.024-5.948; p < 0.001), infections (SMR, 4.946; 95% CI, 4.253-5.639; p < 0.001), cardiovascular diseases (CVD) (SMR, 2.931; 95% CI, 1.802-4.061; p < 0.001), cerebrovascular accidents (CVA) (SMR, 1.588; 95% CI, 0.647-2.528; p = 0.001), and cancer (SMR, 1.698; 95% CI, 0.871-2.525; p < 0.001). Conclusions This meta-analysis shows a significant 2.87-fold elevation in the SMR among patients with SLE compared to the general population, transcending differences in sex or geographical regions. Moreover, an appreciable increase in mortality due to specific causes, including renal disease, infection, CVD, CVA, malignancy, and neuropsychiatric SLE, accentuates the imperative for targeted interventions to mitigate these elevated risks in SLE patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.063 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".