Infections and systemic lupus erythematosus

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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“…Nevertheless, a recent study has shown that infections are a major cause of mortality in both early and late in the course of SLE. 35…”

Section: Discussionmentioning

confidence: 99%

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

Rianthavorn

Prurapark

2019

Lupus

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“…The use of cyclophosphamide, prednisone and azathioprine has also been associated with herpes zoster infections. 23,27,28 In contrast, a previous study by Ruiz-Irastorza et al on the risks of infection among SLE patients has reported a 16-fold reduction in risk of major infection in patients prescribed with antimalarials namely hydroxychloroquine and chloroquine. This was supported by other studies by Siso et al (2008) and Bulthink.…”

Section: Management Of Sle Patients With Latent and Active Tb Infection Latent Tb Infectionmentioning

confidence: 84%

“…Even so, other studies have shown that the use of cyclophosphamide is associated with urinary tract infections, with haemorrhagic cystitis being one of the known complications of cyclophosphamide use. [23][24][25][26] Whereas, mycophenolate mofetil use has also been associated with cystitis, upper airway infection, bronchitis and cellulitis. The use of cyclophosphamide, prednisone and azathioprine has also been associated with herpes zoster infections.…”

Section: Management Of Sle Patients With Latent and Active Tb Infection Latent Tb Infectionmentioning

confidence: 99%

Recurrent Mycobacterium tuberculosis infection in systemic lupus erythematosus patient: case report and review

Sunjaya¹,

Amelia²

2019

JKKI

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Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterised by an underlying immunodeficiency state, worsened by the use of immunosuppressive drugs in its treatment. Hence patients with SLE are at increased risk of opportunistic infections, one of which is tuberculosis. Tuberculosis (TB) is one of the most common infectious diseases globally, with Indonesia having the second highest prevalence in the world. Further research towards better management of these two disease entities is thus required. We report a patient with SLE flare and recurrent tuberculosis infection. Lupus eritematosus sistemik (SLE) merupakan kelainan autoimun yangditandai dengan kondisi imunodefisiensi, yang diperburuk kondisinya selama pengobatan dengan penggunaan obat imunosupresif. Pasien dengan SLE memiliki risiko infeksi oportunistik, salah satunya adalah tuberkulosis. Tuberkulosis (TB) adalah salah satu penyakit menular yang paling umum di dunia. Indonesia memiliki prevalensi tertinggi kedua di dunia. Oleh karena itu diperlukan penelitian lebih lanjut mengenai manajemen yang lebih baik dari penyakit ini. Kami melaporkan seorang pasien dengan ruam SLE dan infeksi tuberkulosis berulang.

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“…30 Cyclophosphamide is a cytotoxic alkylating medication that interferes with lymphocyte proliferation, reducing the production of effector and cytotoxic T cells, as well as autoantibody production. 31 The response of cytotoxic T lymphocytes is crucial for viral eradication in COVID-19. Patients with severe forms of COVID-19 present with perivascular lymphocytic infiltrates and the depletion of almost all T-cell subtypes.…”

Section: Discussionmentioning

confidence: 99%

“…30 Cyclophosphamide reduces antibody production, thus also interfering with the humoral response to the virus. 31 The COVID-19 Global Rheumatology Alliance also observed worse outcomes in patients with SLE and COVID-19 who were on cyclophosphamide treatment. 32 The present study did not observe worse outcomes in patients treated with rituximab, as reported by some studies.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register

Carvalho

Neto

Kakehasi

et al. 2022

Lupus

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Objectives To evaluate factors associated with COVID-19 severity outcomes in patients with systemic lupus erythematosus (SLE). Methods This was a cross-sectional analysis of baseline data of a prospective, multi-stage cohort study—“The ReumaCoV Brazil”—designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. SLE adult patients with COVID-19 were compared with those without COVID-19. SLE activity was evaluated by the patient global assessment (PGA) and SLE Disease Activity Index 2000 (SLEDAI-2K). Results 604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the control group. SLE COVID-19 patients reported a lower frequency of social isolation and worked more frequently as health professionals. There was no difference in the mean SLEDAI-2K score between groups in the post–COVID-19 period (5.8 [8.6] vs. 4.5 [8.0]; p = 0.190). However, infected patients reported increased SLE activity according to the Patient Global Assessment (PGA) during this period (2.9 [2.9] vs. 2.3 [2.6]; p = 0.031. Arterial hypertension (OR 2.48 [CI 95% 1.04–5.91], p = 0.041), cyclophosphamide (OR 14.32 [CI 95% 2.12–96.77], p = 0.006), dyspnea (OR: 7.10 [CI 95% 3.10–16.23], p < 0.001) and discontinuation of SLE treatment medication during infection (5.38 [CI 95% 1.97–15.48], p = 0.002), were independently associated with a higher chance of hospitalization related to COVID-19. Patients who received telemedicine support presented a 67% lower chance of hospitalization (OR 0.33 [CI 95% 0.12–0.88], p = 0.02). Conclusion Hypertension and cyclophosphamide were associated with a severe outcome, and telemedicine can be a useful tool for SLE patients with COVID-19.

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Infections and systemic lupus erythematosus

Cited by 18 publications

References 25 publications

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

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

Recurrent Mycobacterium tuberculosis infection in systemic lupus erythematosus patient: case report and review

Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register

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