Objective To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called “planned pregnancy.” Methods. A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded. Results The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8–17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5–21.8) were associated with composite fetal APOs. Conclusion Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.
The objective of this study is to investigate the current situation of hospital-acquired infection (HAI) in lupus patients from a southern Chinese population. A case-control study was performed. Data from Jan. 2007 to Jan. 2017 were collected. Each lupus patient with HAI was compared with two control individuals without infection selected from the same period of time. Three hundred and sixty episodes of HAI were analyzed. The average Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score at admission was 13.2 ± 7.2. The respiratory tract (58.8%) was most commonly involved, followed by the bloodstream (10.9%). Most episodes were bacteria-associated (50.0%), followed by viral infection (34.8%) and fungal infection (15.2%). Pathogenic bacteria were isolated in 87 episodes, among which 60 episodes were gram-negative bacteria (GNB)-related. Multidrug-resistant strains were detected in 46.4% of bacterial isolates. Fungi were isolated in 49 episodes. Candida albicans (46.9%) was the leading pathogen. Fifty-four episodes of virus infection were confirmed. In multivariate analysis, SLEDAI score (OR 1.1, 95% CI 1.1-1.2, P < 0.001), lupus nephritis (OR 3.7, 95% CI 2.7-5.1, P < 0.001), high dose of GC (OR 2.7, 95% CI 1.8-3.9, P < 0.001), and treatment with CYC (OR 2.9, 95% CI 2.1-4.0, P < 0.001) were risk factors for HAI. HAI in Chinese lupus patients had a unique epidemiology feature, which was characterized by common respiratory tract and bloodstream involvement and predominance of GNB with a high drug resistance rate. A variety of new pathogens including fungi and viruses emerged in the HAI patients. A history of nephritis or a higher SLEDAI score in SLE patients predicted HAI. Moreover, treatment with high dose of GC and CYC was also the main risk factor for HAI.
Aims/Introduction: A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results: Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria.The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 -2.5 vs 7.7 -2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions: Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.
Objective To investigate the characteristics and associated factors of invasive fungal disease in patients with systemic lupus erythematosus from Southern China. Methods A retrospective study was performed. Demographic and clinical characteristics, laboratory data, and radiographic manifestations were recorded. Results A total of 45 lupus patients with invasive fungal disease (incidence 1.1%) were included. Twenty-three cases (51.1%) were infected with mold and 22 cases (48.9%) with yeast. Aspergillus spp. (44.4%) and Cryptococcus spp. (33.3%) were common. Aspergillosis mainly occurred in the lung. Cryptococcosis developed in the lung (40.0%), meninges (46.7%) and bloodstream (13.3%). Compared with yeast infection, mold infection tended to develop in patients with active lupus nephritis (65.2% vs. 31.8%, P = 0.03) and the mortality rate was higher (20.0% vs. 0%, P = 0.001). Co-infection with bacteria, virus or superficial fungi occurred in 12 patients (26.7%). Multivariate logistic regression analysis indicated that lymphopenia (odds ratio 2.65, 95% confidential interval 1.14–6.20, P = 0.02) and an accumulated dose of glucocorticoid (odds ratio 1.58, 95% confidence interval 1.10–2.25, P = 0.01) was associated with invasive fungal disease in lupus patients. Conclusion Mold infection tended to develop in patients with active lupus disease with high mortality. Co-infection is not rare. Lymphopenia and an accumulated dose of glucocorticoid are associated with invasive fungal disease in lupus patients.
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