Clinical research Characteristics of comorbidities and costs among patients who died from systemic lupus erythematosus in Taiwan Shih-Chao Kang1,2, Shinn-Jang Hwang2,3, Yu-Sheng Chang4, Chung-Tei Chou2,4, Chang-Youh Tsai2,4 1Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan 2Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan 3Department of Family Medicine, Taipei Veterans General Hospital, Taiwan 4Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan Submitted: 4 November 2011 Accepted: 11 March 2012 Arch Med Sci 2012; 8, 4: 690-696 DOI: 10.5114/aoms.2012.30293 Copyright © 2012 Termedia & Banach A b s t r a c t Introduction: Systemic lupus erythematosus (SLE) is prevalent among young female adults, particularly in Asia. In Taiwan, features of end-of-life SLE patients remain unclear. Material and methods: Data regarding SLE patients whose hospitalization end- ed up with death were collected and analyzed from the repository of the Nation- al Health Insurance Research Database, Taiwan, from 2005 to 2007. Results: A total of 302 subjects were enrolled and the majority of these were young to middle-aged women (45.8 ±18.5 years); only one third of them were treated by rheumatologists. Eight patients (2.6%) with comorbid cancers received hospice care. Sepsis/bacteremia (42.1%) was the major acute comorbidity. Nephropathy/nephritis (35.1%) represented the major chronic comorbidity. Among 27 subjects with comorbid cancers, gynecological cancers were the most common (18%). Among the inpatient costs, the cost of prescriptions account- ed for the majority (21.7 ±11.5%). Under a multivariate logistic regression, advanced age (≥ 65 years) correlated positively with acute lower respiratory conditions (ALRC) and diabetes mellitus (DM), and male gender correlated neg- atively with nephropathy/nephritis. The nephropathy/nephritis correlated pos- itively with hospital stays > 14 days. The ALRC was closely associated with acute respiratory failure, but not with shock. However, shock was closely associated with hospital stays ≤ 14 days and sepsis/bacteremia. Cancer development was inversely correlated to nephropathy/nephritis, acute respiratory failure, and shock (all p < 0.05). Conclusions: The end-of-life SLE patients revealed aforementioned characteris- tics and relationships. Sepsis/bacteremia, acute respiratory failure, and ALRC contributed most frequently to the ultimate death of acutely ill SLE patients. Key words: comorbidity, retrospective study, impending death, systemic lupus erythematosus. Introduction Systemic lupus erythematosus (SLE) is prevalent among young women, particularly in non-Caucasian populations. Patients are frequently hospitalized as they suffer from pneumonias or urinary tract infections Corresponding author: Prof. Chang-Youh Tsai Division of Allergy, Immunology and Rheumatology Department of Medicine Prof. Shinn-Jang Hwang Department of Family Medicine Taipei Veterans General Hospital 201 Shih-Pai Road Sec. 2 Taipei 112, Taiwan, ROC Phone: +886-2-28757460 Fax: +886-2-28737901 E-mail: cytsai@vghtpe.gov.tw, sjhwang@vghtpe.gov.tw