Background Mortality in SLE has a bimodal peak with early deaths mainly related to disease activity and infection. Although mortality has reduced over years, it is still two to three folds compared to the general population. In India due to increased burden of infection and limited access to health care, the causes may be different. Methods Retrospective, review of records of all adult SLE patients fulfilling ACR 1997 criteria, who died in hospital between 2000-2019 at a teaching hospital in India was done. In addition, baseline clinical features were extracted for all adult SLE patients seen during this period. Infections were either bacteriologically proven or based on clinicradiological or serologic evidence. Active disease was defined as SLEDAI 2k ≥ 5. Logistic regression was performed to ascertain risk factors for mortality. Results A total of 1337 (92% females) patient records were reviewed .The mean age at presentation was 29.9 ± 9 years.60–75% of patients had fever, mucocutaneous disease and arthritis, while nephritis, hematologic, serositis and neurologic involvement was seen in 48.6%, 43.2%, 16% and 10.3% respectively as presenting mainfestations. There were 80 in hospital deaths .Infection was the most common cause of death, with 37 due to infection alone and in 24 disease activity also contributed. Only 18 deaths were due to active disease. Among bacterial infections lung was the most common site and gram negative organism were the most common pathogens. There were 10 deaths due to Tuberculosis(TB) and half of them had disseminated disease. Patients with disease activity had a SLEDAI of 14.8 ± 6.4, with neurological, renal and cardiovascular involvement being the major contributors to mortality in 11, 7 and 6 cases respectively. Higher age at onset, male gender, fever, myositis, neurological, cardiovascular, gastrointestinal involvement, vasculitis, elevated serum creatinine at baseline were independent predictors of death. Conclusion Infections are the most common cause of in-hospital mortality in SLE and TB still accounts for 15% of deaths related to infection. Vasculitis, myositis, cardiovascular and gastrointestinal involvement emerged as novel predictors of mortality in our cohort.

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Aims of this study: Severe acute pancreatitis has been defined recently based on the persistence of organ failure at 48 hours of admission. The bedside index for severity in acute pancreatitis (BISAP) score, a simplified scoring system to predict severity of acute pancreatitis, is proposed to be useful in early risk stratification of acute pancreatitis. Our aim was to prospectively compare BISAP score with the already established acute physiology and chronic health evaluation II (APACHE II) and modified computed tomography severity index (CTSI) scores in predicting the severity of acute pancreatitis. Materials and methods: A total of 87 consecutive cases presenting with the first attack of acute pancreatitis were included in the study. Acute physiology and chronic health evaluation II and BISAP scores were calculated from the worst parameters in the first 24 hours, and modified CTSI was reported at 48 hours of admission. Receiver-operating characteristic (ROC) curves were plotted, and predictive accuracy of each score was calculated from the area under the curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each score. Results: A total of 20 patients (23%) had severe acute pancreatitis with a total of 11 mortalities (12.64%), 10 of them in the severe acute pancreatitis group. Acute physiology and chronic health evaluation II, modified CTSI, and BISAP score all correlated well with each other. Modified CTSI and BISAP score also correlated with duration of hospital stay. Areas under the curve for APACHE II (≥8), modified CTSI (≥8), and BISAP score (≥2) were 0.826, 0.806, and 0.811, respectively, suggesting similar predictive accuracy. Conclusion:The BISAP score was similar to APACHE II and modified CTSI in terms of accuracy, sensitivity, specificity, and NPV. It is much easier to calculate and a useful risk stratification tool. It should be used for early triage and referral to a high dependency unit.

Objective To determine the prevalence, profile and predictors of infections in an Indian cohort of IIM. Methods We reviewed the records of a retrospective cohort of IIM enrolled from consecutive patients following up in the clinic as the observation cohort (OC). A newly diagnosed inception cohort of IIM were followed prospectively as the validation cohort (VC) to confirm observations and compare with the OC. Results Among 68 patients in the OC (age 33.4 years, F: M 4.2:1), 37(54.4%) experienced 54 infections, of which 21(38.8%) were major and recurrent infections in 11 patients(16.17%) over 3.08 years. Tuberculosis was the most common infection(12, 22.2%), with predominance of extra-pulmonary forms. Serum protein(OR 0.44), platelets(0.44) at disease onset and daily steroid dose(1.04) predicted major infections on multivariate analysis. A higher daily dose of steroids at first infection correlated with number of recurrent infections. Infection free one-year survival was 73.8%. Of 70 patients in VC (35.7 years, F: M 3.7:1), three had myositis attributed to an infection. Similar proportion of total(22, 33.3%), major(10, 45.4%) and recurrent(4,18%) infections were recorded. Most common infection was community acquired pneumonia, followed by Tuberculosis with serum albumin(OR 0.25) at disease onset being the only predictor. One-year infection free survival was 64.7%. Those who had a major infection had increased mortality at 1 year with survival of 60% compared with 89.09% in those without. In both cohorts, a daily prednisone dose >6.25 mg predisposed to major infections. Conclusion Major and recurrent infections are common in Indian IIM patients and confer higher risk for future infections and lower survival. Respiratory and atypical bacterial infections such as Tuberculosis occur throughout the disease course.

This study is a first initiative to "fill the gap" in the social marketing research literature by providing recruitment and program design information specifically for developing a smoking cessation campaign for university campuses.