Shih-Chao Kang, Shinn-Jang Hwang, Yu-Sheng Chang, Chung-Tei Chou, Chang-Youh Tsai ed in the aforementioned epidemiological studies. Regarding the details of cost, a large proportion was allocated to drug prescriptions to maintain vital organs as well as the laboratory tests accompany- ing these tasks. It is conceivable that late compli- cations of SLE are so extensive and catastrophic that they would account for most of the life-long treatment costs. Interestingly, subjects who re- ceived hospice care had significantly lower total costs for end-of-life hospitalization than the oth- ers (1,664 ±3,014 vs. 9,744 ±10,401 USD, p < 0.001 by two-sample t-test). The cost-saving benefits of hospice care have been confirmed by previous stud- ies and might be considered as an alternative way to care for terminal SLE patients [15-17]. For acute/chronic comorbidities in end-of-life SLE The acute comorbidities in end-of-life SLE patients provided clues to the mortality issues. In other countries or areas, previous epidemiological and hospital-based studies have identified infec- tions as the leading cause of death in SLE patients [18-20]. In Taiwan, Feng et al. reported that inade- quate use of antibiotics and prolonged hospital stays increased the mortality of SLE patients in intensive care units [21]. Similarly, our results demonstrated that sepsis/bacteremia, acute respi- ratory failure and ALRC were the three most com- mon acute comorbidities in dying SLE patients. These conditions are likely to have a major impact on SLE patients during their end of life. We sup- posed that hematogenous infections were the most difficult factor to deal with in terms of treating patients with life-threatening SLE. Among the chronic comorbidities, nephropa- thy/nephritis prevailed in dying SLE patients. This was consistent with reports showing a high preva- lence of lupus renal diseases in Orientals [22]. Anoth- er study has also reported an increasing trend of Medicare expense in parallel to the increasing inci- dence of renal damage in SLE patients [23]. In this study, we can see that nephropathy/nephritis in SLE patients claimed significantly higher total expens- es for hospitalization, particularly during the end of life (11,710 ±10,885 vs. 8,351 ±9,885, p = 0.007 by two-sample t-test), although relatively longer hos- pital stay might be a confounding factor. This sug- gests that early prevention or treatment of nephropathy/nephritis is an essential requirement to save costs that may be ultimately incurred by pro- longed and expensive treatment for catastrophic complications of SLE. Our results have demonstrated that 5% of dying SLE patients had concurrent DM, a figure similar to those reported elsewhere. It has been widely accepted that patients with SLE have a higher risk for metabolic syndrome, coronary artery disease and/or stroke [24, 25]. Our results showed a high- er prevalence of DM in male SLE patients approach- ing death (7.3% vs. 4.7-6.5% in general male po- pulation; 4.6% vs. 5.3-6.6% in general female population) in Taiwan [26]. Also, the prevalence of acute cerebrovascular accidents in our patients was higher than those reported previously [27, 28]. On the other hand, occurrence of acute myocardial infarction was similar to those reported endemi- cally [29]. These have suggested that prolonged inflammation or autoimmune processes can lead to the development of vascular damage that sub- sequently results in fatal cerebrovascular or car- diovascular episodes. For relationships of logistic regressions Significant associations or correlations have been observed in this study. For example, older patients tended to have more chance of getting diabetes, patients with ALRC were more prone to acute res- piratory failure, and patients with non-traumatic shock tended to have sepsis/bacteremia as their cause. We supposed that these conditions could be induced by glucose intolerance and immunosup- pressive status after long-term use of corticos- teroids. In addition, it is interesting that nephropa- thy was more frequently identified in younger patients and associated with a prolonged hospital stay. Regarding the latter, no compelling data could support this finding up to now. It needs further clar- ification. Regarding the former, Pelletier et al. demonstrated a similar risk in American SLE popu- lations [14]. Another Canadian study also reported a higher incidence of nephropathy in younger patients with early onset of illness in non-Caucasian pediatric SLE patients [30]. Furthermore, more rap- id progression of nephropathy and lower survival rates were reported in non-Caucasian SLE patients [31]. Our results demonstrated a similar character- istic of nephropathy/nephritis, including LN. This suggests that earlier diagnosis and control of nephropathy are essential for reducing mortality rates and medical costs in SLE patients. Non-traumatic shock was associated with short- er hospital stays and fewer ALRC. The most likely cause of shorter hospitalization time was rapid deterioration course resulting in death in these immunosuppressive patients. This reflected the impact of shock on the progression of the illness. The association between fewer ALRC and more non- traumatic shock implied that the major pattern of infections might be sepsis/bacteremia without spe- cific origins in critical SLE patients due to their poor- er immunosuppressive status. Actually, in many patients dying of septic shock the original source of infection could not be definitely identified. So, occult infections should be looked for and careful- ly evaluated for every critical SLE patient [32]. 694 Arch Med Sci 4, August / 2012