Clinical characteristics and risk factors of infections in patients with systemic lupus erythematosus

Hou, Cheng-Cheng; Jin, Ou; Xi, Zhang

doi:10.1007/s10067-018-4198-8

Cited by 26 publications

(25 citation statements)

References 23 publications

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“…45,48 Infection, which was the second most common cause of death, has been identified as a frequent cause of death in early SLE and can be linked to high disease activity, high doses of corticosteroids, immunosuppressive therapy and hospitalization. 46,49 Early cardiovascular disease has frequently been reported as being overrepresented in SLE, especially in women, and remains a prevailing cause of death, also corroborated in this study. 14,50…”

Section: Discussionsupporting

confidence: 88%

The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts

Frodlund

Reid

Wetterö

et al. 2019

Lupus

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Background Although the survival of patients with systemic lupus erythematosus (SLE) has improved, irreversible organ damage remains a critical concern. We aimed to characterize damage accrual and its clinical associations and causes of death in Swedish patients. Methods Accumulation of damage was evaluated in 543 consecutively recruited and well-characterized cases during 1998−2017. The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI) was used to estimate damage. Results Organ damage (SDI ≥ 1) was observed in 59%, and extensive damage (SDI ≥ 3) in 25% of cases. SDI ≥ 1 was significantly associated with higher age at onset, SLE duration, the number of fulfilled SLICC criteria, neurologic disorder, antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia, depression and secondary Sjögren's syndrome (SS). In addition, SDI ≥ 3 was associated with serositis, renal and haematological disorders and interstitial lung disease. A multiple regression model identified not only well-known risk factors like APS, antihypertensives and corticosteroids, but pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked to SDI. Malignancy, infection and cardiovascular disease were the leading causes of death. Conclusions After a mean SLE duration of 17 years, the majority of today's Swedish SLE patients have accrued damage. We confirm previous observations and report some novel findings regarding disease phenotypes and damage accrual.

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Section: Discussionsupporting

confidence: 88%

The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts

Frodlund

Reid

Wetterö

et al. 2019

Lupus

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“…Active SLE can lead to infection as a result of the disease state itself and the use of intense immunosuppressive therapy, and infections can induce SLE flares. 25,26 In this study, high SLEDAI scores were observed but SLEDAI scores were similar between surviving and deceased patients. The finding that the SLEDAI score is not a mortality risk is consistent with studies in adult patients with SLE and infection.…”

Section: Discussionmentioning

confidence: 42%

Risk factors of infection-associated mortality in children with lupus nephritis in under-resourced areas

Rianthavorn

Prurapark

2019

Lupus

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Introduction Treatment of lupus nephritis class III, IV and V with immunosuppressive therapy increases patient survival but poses a risk of infection-related mortality. This study was conducted to evaluate risk factors for fatal infection in children with lupus nephritis in under-resourced areas. Methods Medical records of patients, who were admitted to a tertiary-care university-based hospital from January 2002 to July 2018 with the diagnosis of systemic lupus erythematosus, were reviewed. Only patients aged less than 18 years with lupus nephritis and documented infection were included in the study. The primary outcome was infection-associated mortality. The logistic regression model was used to identify independent variables associated with fatal infection. Predicted probabilities of infection-related mortality adjusted for factors significant in multivariate analysis were calculated using marginal effects at representative values. Results Infection-related deaths occurred in 27 of 179 patients (15.1%). Hospital-acquired infections occurred in 72 of 375 episodes of hospital admissions (19.2%) and 13 hospital-acquired infections (18.1%) resulted in fatal infection. Invasive fungal infections were the leading cause of death (44.4%) and pulmonary infections were the predominant site (55.5%). Haemoglobin levels and glomerular filtration rates were significantly lower in deceased versus surviving patients. Percentages of patients with hospital-acquired infections, invasive fungal infections and pulmonary infections were significantly higher in deceased than surviving patients. Urine protein, the neutrophil-to-lymphocyte ratio, cumulative methylprednisolone dose and daily prednisolone dose were significantly higher in deceased than surviving patients. In multivariate analysis, a neutrophil-to-lymphocyte ratio more than 20, invasive fungal infections and high daily prednisolone dose were independently predictive of fatal infection with adjusted odds ratio of 3.02 (95% confidence interval 1.02–8.97, p = 0.04), 15.08 (95% confidence interval 4.72–48.24, p < 0.001) and 1.03 (95% confidence interval 1.01–1.06, p = 0.04), respectively. A high daily prednisolone dose intensified the impact of invasive fungal infections and high neutrophil-to-lymphocyte ratio on predicted probability of infection-associated mortality. Conclusions Prevention of invasive fungal infections and minimization of daily prednisolone should be emphasized in routine clinical practice of children with lupus nephritis in under-resourced areas to achieve better survival. Children with lupus nephritis and a high neutrophil-to-lymphocyte ratio should be under cautious surveillance for infection.

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“…Most previous studies have collected data in the 1990s; the treatment patterns and characteristics of disease in this period were different from those in the 2000s. In recent reports, infection had not been correlated with disease activity markers, but with treatment patterns 15,25 . In addition, this study collected serious infection cases requiring admission or intravenous antibiotics.…”

Section: Discussionmentioning

confidence: 96%

Associated clinical factors for serious infections in patients with systemic lupus erythematosus

Jung

Yoon

Choi

et al. 2019

Sci Rep

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Infection occurs frequently in patients with systemic lupus erythematosus (SLE), and has been a major cause of morbidity and mortality. However, no large-scale comprehensive studies have estimated the effect of clinical characteristics on serious infection in actual clinical practice yet. We investigated the influence of clinical characteristics on serious infections using electronic medical records data. We conducted a nested case-control study. Patients with SLE who developed serious infection which needs hospitalization or intravenous antibiotics (n = 120) were matched to controls (n = 240) who didn’t. Odds ratios (OR) and 95% confidence intervals (CIs) for infection associated with clinical features were obtained by conditional logistic regression analyses. The conditional logistic regression analysis with adjustment showed that serositis (OR, 2.76; 95% CI, 1.33–5.74), hematologic involvement (OR, 2.53; 95% CI, 1.32–4.87), and use of higher than the low dose of glucocorticoids (GCs; >7.5 mg/d prednisolone-equivalent) (OR, 2.65; 95% CI, 1.31–5.34) were related to serious infections in SLE. Serositis, hematologic involvement, and use of higher than the low dose of GCs were associated with serious infections in patients with SLE.

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Clinical characteristics and risk factors of infections in patients with systemic lupus erythematosus

Cited by 26 publications

References 23 publications

The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts

The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts

Risk factors of infection-associated mortality in children with lupus nephritis in under-resourced areas

Associated clinical factors for serious infections in patients with systemic lupus erythematosus

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