Survival analysis of a Lupus cohort.

John, Mathew (2010) Survival analysis of a Lupus cohort. Masters thesis, Christian Medical College, Vellore.

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Abstract

BACKGROUND : Systemic Lupus Erythematosus is one of the common illnesses in a Rheumatology department. It affects mostly women in the reproductive age group. Few decades back it was a disease with high mortality. There has been an increasing understanding on the etio-pathogenesis of this disease. Improved investigations and treatment modalities have improved the survival of these patients significantly. Most of this data is from developed countries. In view of the difference in background health of the population, differences in availability of health care, and genetic differences the survival needs to defined for an Indian population in an Indian setting. This study attempts to do this, particularly because the information from India regarding his is limited. METHODS : A cohort of225 patients admitted in CMC from 2007 to 2010 were assessed for their duration of survival since diagnosis. This group of patients had their various parameters documented during the admission in their history, examination, investigations and treatment. This was retrieved onto an excel sheet from the clinical work station. These patients were followed up during their review visits in the outpatient or inpatient setting as the case may be. A Kaplan Meir survival curve was made for these patients. Their significance of correlation with any of the clinical or laboratory indices were evaluated by log rank test. The same group of patients was also assessed for evidence of organ damage. RESULTS : The survival of our patients at 1-,3-, 5-, 10- and 15- years were 97.6%, 95.6%,93.8%, 83% and 83% respectively. This survival rate is comparable with survival from developed countries for up to 5 years. At 10 years our survival is less than developed countries. The survival rate is better than previous data from India which was from one to two decades back. Other than the number of criteria fulfilled for the diagnosis (The 1997 update of the 1982 revised ACR classification criteria for SLE), and use of Mycophenolate, Azathioprine or Cyclophosphamide none of the other parameters showed a significant correlation with survival in our study. The mean survival time of the SLE patients with these different parameters are also calculated in this study. The median duration of symptoms before a diagnosis was made for our cohort was 6 months, with 25 percentile having a diagnosis at 3 months and 75 percentile having a diagnosis at 18 months. The common organ damages were cataract, seizures, end stage renal disease and diabetes mellitus. CONCLUSION : 1. The five year survival of our south Asian cohort of SLE patients is 95.6% which is comparable with other published international cohorts. There is an improved survival of SLE patients in this south Asian cohort compared to previously published literature from the subcontinent 2. The ten year survival of our cohort is 83% which is better than all previously published cohorts from south Asia, but is less than other cohorts from the developed world. 3. The commonest organ damage or its manifestations in our cohort of patients is seizures followed by diabetes mellitus, end stage renal disease and cataract in decreasing order of frequencies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Survival in SLE ; organ damage in SLE ; Kaplan Meir survival curve in SLE ; Lupus cohort.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 19 Aug 2017 03:47
Last Modified: 20 Aug 2017 03:51
URI: http://repository-tnmgrmu.ac.in/id/eprint/1806

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