Impact of severe infections in SLE: an observational study from the Spanish national registry

Abstract

ObjectiveInfections are a common complication of SLE. Our objective was to evaluate their causes and impact on the survival of patients with SLE.MethodsAnalysis of the admissions and death causes in patients diagnosed with SLE from the Spanish Hospital Discharge Database and the infection-related deaths of the Spanish population from the National Statistical Institute, between 2016 and 2018.Only infections recorded as the main diagnosis were analysed (severe or clinically relevant infection).ResultsAmong 18 430 admissions in patients with SLE, disease activity was the cause of admission in 19% of all patients and infection in 15%. However, infection was the main cause of death (25%) while SLE activity was responsible for only 6% of deaths (p<0.001). Severe infection exceeded SLE as a cause of death for patients dying at ages between 40–59 (23% vs 4%, p<0.001), 60–79 (26% vs 6%, p<0.001) and older than 80 years (25% vs 6%, p<0.001). Infection was the cause of death in 8% of the Spanish population, a significantly lower rate when compared with patients with SLE (p<0.001). Compared with the general population, infections were the highest relative cause of death in patients with SLE, particularly at younger ages: 40% vs 3% for those below 20 years old (p<0.01), 33% vs 4% between 20 and 39 (p<0.001), 23% vs 5% between 40 and 59 (p<0.001), 26% vs 5% between 60 and 79 (p<0.001) and 25% vs 9% for those older than 80 years (p<0.001).ConclusionOur nationwide study confirms that infections are the leading cause of death in SLE in Spain, with the highest proportion occurring in young patients with lupus compared with the general population of the same age range.

Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE

“…This is similar to the long term outcomes from a UK cohort with infections as the leading cause of death at 31.7% [ 48 ]. Infection attributable mortality ranged from 23 to 26% in a Spanish cohort which also corresponded to a threefold increase over the general population (25% versus 8%) [ 53 ]. Infections also conferred a hazard ratio for mortality of 2.79 on long-term follow-up of the Hopkins lupus cohort from the USA [ 54 ].…”

Higher mortality risk from gynaecological neoplasms and non-Hodgkin’s lymphoma in patients with systemic lupus erythematosus: an observational study from the Spanish National Registry

“…on May 31, 2024 Lupus Science & Medicine complications of SLE have become more important, such as the high prevalence of cardiovascular disease, the risk of neoplasms and the impact on quality of life, among others. [8][9][10] Here, several reports have evaluated the incidence of certain neoplasms in patients with SLE, since both the disease itself and subsequent chronic inflammation or immune system dysregulation, as well as the drugs prescribed and immunosuppression, can lead to a higher cancer risk. [11][12][13] However, some of these studies were limited by sample size and monocentric design, often with an insufficient follow-up period.…”

Systemic lupus erythematosus: one year in review 2023

“…• In a precision medicine perspective, SLE treatment would be based on the genetic profiles of individual patients related to pathogenesis and response therapy (64-66). (71). The greatest differences were found in relation to respiratory tract infections, sepsis and viral infections, emphasising the need for measures to mitigate the impact of infections in these patients.…”