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Background <p>Systemic lupus erythematosus (SLE), an autoimmune disease, damages multiple organs. Studies showed higher all-cause mortality in SLE patients compared to the general population. However, it remains unclear whether the persistent immunodeficiency and organ damage exacerbate the prognosis of intensive care for patients with comorbid SLE.</p> Methods <p>A cohort of 50,920 critically ill patients from 2008 to 2019 in USA was obtained from the MIMIC IV database. Matching was employed to create control groups, mitigating the influence of known confounders. Wilcoxon test and Pearson’s Chi-squared Test were utilized to compare quantitative and categorical variables between groups, respectively. Log-rank test was used to compare survival differences. Univariate and multivariate Cox regression analyses were conducted to explore influencing factors. Mediation analysis was employed to investigate the mediating role of influencing factors.</p> Results <p>Patients with comorbid SLE showed notably lower 180-day survival than controls (HR = 1.485, <i>P</i> = 0.015). While hemoglobin, platelets, white blood cells, creatinine, urine output, SOFA performed significance in univariate Cox regression analysis, only creatinine and urine output remained significant in multivariate analysis. Mediation analysis revealed the significant mediating effect of renal function (represented by creatinine). SLE patients treated with glucocorticoids did not exhibit a significant decrease in survival compared to controls (HR = 1.482, <i>P</i> = 0.095), whereas those without glucocorticoids showed a significant decrease (HR = 1.660, <i>P</i> = 0.027).</p> Conclusion <p>SLE diminishes survival among critically ill patients by affecting renal function, while glucocorticoids can partially mitigate the decline in survival.</p>

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Systemic lupus erythematosus reduces survival of ICU patients mediated by renal dysfunction: retrospective study of critically ill patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月1日

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  • Hongjing Zhang,
  • Yimei Ding,
  • Hong Zhang,
  • Jia Zhou,
  • Wenxiong Zhou

摘要

Background

Systemic lupus erythematosus (SLE), an autoimmune disease, damages multiple organs. Studies showed higher all-cause mortality in SLE patients compared to the general population. However, it remains unclear whether the persistent immunodeficiency and organ damage exacerbate the prognosis of intensive care for patients with comorbid SLE.

Methods

A cohort of 50,920 critically ill patients from 2008 to 2019 in USA was obtained from the MIMIC IV database. Matching was employed to create control groups, mitigating the influence of known confounders. Wilcoxon test and Pearson’s Chi-squared Test were utilized to compare quantitative and categorical variables between groups, respectively. Log-rank test was used to compare survival differences. Univariate and multivariate Cox regression analyses were conducted to explore influencing factors. Mediation analysis was employed to investigate the mediating role of influencing factors.

Results

Patients with comorbid SLE showed notably lower 180-day survival than controls (HR = 1.485, P = 0.015). While hemoglobin, platelets, white blood cells, creatinine, urine output, SOFA performed significance in univariate Cox regression analysis, only creatinine and urine output remained significant in multivariate analysis. Mediation analysis revealed the significant mediating effect of renal function (represented by creatinine). SLE patients treated with glucocorticoids did not exhibit a significant decrease in survival compared to controls (HR = 1.482, P = 0.095), whereas those without glucocorticoids showed a significant decrease (HR = 1.660, P = 0.027).

Conclusion

SLE diminishes survival among critically ill patients by affecting renal function, while glucocorticoids can partially mitigate the decline in survival.