Impact of systemic lupus erythematosus on the 5-year survival of critically ill septic patients

Abstract

Background Infectious disease is an increasing threat to patients with systemic lupus erythematosus (SLE); however, the long-term outcome in critically ill septic patients with SLE remains unclear, and we aimed to address the impact of SLE on 5-year survival in critically ill septic patients. Methods We used the 2003–2017 nationwide data with 825,556 patients with sepsis in Taiwan. We identified lupus cases with sepsis that required admission to the intensive care unit and mechanical ventilation and selected controls matched (1:4) for age, sex, and index-year. Conditional logistic regression analysis was used to determine risk factors for mortality risk and shown as odds ratios (HRs) with 95% confidence intervals (CIs). Results A total of 513 SLE-sepsis patients and 2052 matched non-SLE septic individuals were enrolled. The mortality rate was higher in the SLE group (38.5 per 100,000 person-year) than that in the non-SLE group (13.7 per 100,000 person-year), with an IRR of 2.8 (95% CI, 2.5–3.2). We found that SLE was independently associated with a high mortality rate after adjusting relevant variables (HR 1.47, 95% CI 1.27–1.77). In addition to SLE, a higher age (HR 1.02, 95% CI 1.02–1.02), more comorbidities, and receiving prednisolone equivalent dose higher than 5 mg/day (HR 1.55, 95% CI 1.27–1.90), methotrexate (HR 2.19, 95% CI 1.61–2.99), and immunosuppressants (HR 1.45, 95% CI 1.22–1.74) were also independent risks for mortality. Conclusions We identified that SLE affects the long-term mortality in critically ill septic patients, and more studies are warranted for the underlying mechanism.

Causal associations between autoimmune disease and sepsis: a two-sample Mendelian randomization study

“…SLE is a chronic multisystem AID characterized by a broad range of laboratory and clinical manifestations. [32,33] Patients with SLE were more likely to succumb to sepsis than non-SLE patients. [25] Moreover, sepsis patients with SLE were observed to have a higher short-term mortality and unfavorable long-term outcomes.…”

“…[6,25] As opposed to that, a population-based case-control study conducted by Chen HH et al revealed that SLE was linked to a higher long-term (5 years) mortality rate in patients with severe sepsis requiring ICU admissions and mechanical ventilation. [33] Surprisingly, Oud, L. and J. Garza contradicted these ndings by suggesting that SLE was associated with a reduced risk-adjusted odds of short-term mortality, and they contended that the increased likelihood of developing sepsis, rather than the higher fatality rate among SLE patients, was the primary driver of the elevated risk of sepsis-related short-term mortality related to sepsis. [8] The con icting ndings mentioned above may be attributed to various factors, including the size of the sample, potential bias in sample selection, cytokine levels at baseline, the use of steroids and immunosuppressive drugs, the severity of sepsis, the methods employed to estimate the cohort's outcome after adjusting for risk, and others.…”