Emergency presentations and factors associated with adverse outcomes in systemic lupus erythematosus: an ambispective observational cohort study

Abstract Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with highly variable clinical manifestations ranging from mild mucocutaneous involvement to life-threatening organ dysfunction. Emergency department (ED) presentations may result from disease flares, infections, or other severe complications requiring urgent or intensive care. Early risk stratification is essential to improve outcomes. Objective To describe clinical and laboratory features, management, and outcomes of SLE patients presenting to the ED, and to identify factors associated with Intensive care unit (ICU) admission and mortality. Methods This ambispective observational study included 50 patients presenting to the Emergency Department (ED) with confirmed SLE, including both previously diagnosed and newly diagnosed patients. Data on clinical features, disease activity, laboratory findings, treatment, ICU admission, and outcomes were analyzed using SPSS version 24. Categorical variables were expressed as numbers and percentages, and continuous variables as mean ± SD. Comparative analyses were performed according to ICU admission and survival. Results Mean age was 32.4 ± 12.1 years; 90% were female. Mean SLEDAI score was 11.2 ± 8.3. The most common causes of admission were disease flare (56%) and infection (34%). Severe presentation occurred in 30% of patients. ICU admission was required in 54%, with ICU and in-hospital mortality rates of 22.2% and 12%, respectively. Severe clinical presentation was significantly associated with ICU admission ( p < 0.001) and mortality ( p = 0.013). Among the immunological variables evaluated, anti-dsDNA positivity ( p = 0.011) and low complement levels (C3 p = 0.013; C4 p = 0.028) demonstrated associations with ICU admission. Although ANA also showed a statistical association, this finding should be interpreted cautiously because ANA testing was performed selectively rather than routinely. Conclusion Clinical severity at presentation is a stronger factor associated with ICU admission and mortality than routine laboratory findings in SLE patients in the ED. Immunological markers and complement depletion are associated with more severe disease, highlighting the importance of early risk assessment.