Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus

The aim of this study was to determine whether early damage accrued in SLE as measured by the SLICC/ACR Damage Index predicts mortality in an inception cohort of lupus patients that have been followed prospectively in a single centre. SLE patients from the University of Toronto Lupus Clinic presenting within 1y of their diagnosis prior to 1988 were included. This enabled all patients to be potentially followed for at least 10y. Yearly SLICC/ACR Damage Index scores were determined for each patient. Early damage was defined as a score 1 1 and no damage as a score of 0 at the initial assessment. Log rank test was used to compare the survival experience between those with and without damage, with ail patients being censored at 10y. Two-hundred and sixty-three patients were identified in this inception cohort who were followed for 10y. One-hundred and ninety patients (72%) had a SLICC/ACR Damage Index score of 0 (no damage) while 73 patients (28%) had at least one SLICC/ACR Damage Index item scored (early damage). Twenty-five percent of lupus patients who exhibited damage at their first SLICC/ACR Damage Index assessment died within 10y of their illness as compared to only 7.3% who had no early damage (log rank P-value = 0.0002). SLE patients who died within 10y were more likely to have renal damage (P=0.013), and a trend toward more cardiovascular disease (P = 0.056), compared to patients who were alive. Early damage as reflected by the initial SLICC/ACR Damage Index is associated with a higher rate of mortality.