Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

Rúa-Figueroa, Íñigo; López‐Longo, Javier; Galindo, María; Calvo‐Alén, Jaime; Campo, Víctor del; Olivé-Marques, Alejandro; Pérez-Vicente, Sabina; Fernández‐Nebro, Antonio; Andrés, Mariano; Erausquin, Celia; Tomero, Eva; Horcada, Loreto; Uriarte, E.; Freire, Mercedes; Montilla, Carlos; Sánchez-Atrio, Ana; Santos, Guilherme Pinheiro dos; Boteanu, Alina; Díez‐Álvarez, Elvira; Narváez, Javier; Martínez‐Taboada, Víctor M.; Silva-Fernández, Lucía; Ruiz-Lucea, Esther; Andreu, José Luís; Hernández‐Beriain, José Ángel; Gantes, M; Hernández‐Cruz, Blanca; Pérez-Venegas, J.J.; Pecondón-Español, Ángela; Marras, Carlos; Ibáñez‐Barceló, Mónica; Bonilla, Gema; Torrente, V.; Castellví, Iván; Alegre, J.J.; Calvet, Joan; Marenco, José Luis; Raya, Enrique; Vázquez, Tania Monzón; Quevedo, Víctor; Muñóz-Fernández, Santiago; Rodríguez–Gómez, Manuel; Ibañez, J.; Pego-Reigosa, José María

doi:10.1016/j.semarthrit.2017.01.010

Cited by 124 publications

(132 citation statements)

References 54 publications

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“…The drugs used in rheumatic diseases can be divided into glucocorticoids, traditional (non-biological) DMARDs, and biological DMARDs. Voluminous previous studies have validated that the usage of certain dosage of GCs would increase the risk of infections, in both RA [28,29] and other types of rheumatic diseases such as SLE and lupus nephritis [22,30,31]. In line with these previous studies, our data revealed the increased risk of serious infection associated with systemic GCs (RR:1.64, 1.52-1.76) among the cohorts although there are subtle differences between different disease types.…”

Section: Discussionsupporting

confidence: 90%

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Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

Ding¹,

Xiang²,

Zhou³

et al. 2020

Preprint

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Background To compare the incidence and risk factors of serious infections among patients of seven common rheumatic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR), Sjögren's syndrome (SS), systemic sclerosis (SSc), systemic vasculitis (VA), and other diffuse connective tissue diseases (oCTD). Methods In a retrospective cohort study using large Electronic Health Records (EHR) data, the infection rates of different rheumatic diseases in two years were calculated and variances on risk factors were analyzed using the multivariable Cox model. Results Among the overall 46,411 rheumatic patients, 8,308 presented serious hospitalized infections in the following two years (crude infection rates (IR) per 100 patient-years: 8.95, 8.76–9.14). SSc (10.89, 9.61–12.16), VA (10.82, 9.96–11.68), and SLE (10.13, 9.73–10.53) had relatively high IRs, while oCTD was with the lowest IR (7.71, 6.58–8.84). The Cox model identified previous infection (adjusted hazard ratio (HR):1.75, 1.62–1.88, p < 0.001), GCs usage (HR:1.64, 1.52–1.76, p < 0.001), nonbiologic DMARDs usage (HR:1.39, 1.32–1.45, p < 0.001) and congestive heart failure (CHF) (HR:1.42, 1.30–1.56, p < 0.001) as the top-ranked risk factors of infection in the overall population. While some of the variables were shared across subtypes of rheumatic diseases as highly associated risk factors, others varied significantly such as osteoporosis. Conclusions Infection rates and risk factors varied among cohorts of different rheumatic diseases. The analytical results may inform distinct strategies and influence clinical decision making to reduce the occurrence of infections.

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Section: Discussionsupporting

confidence: 90%

“…Our study validated as well as provided important complements to the current literature on the risk of serious infections associated with rheumatic diseases. Our analyses found a 20.4% prevalence of severe infection among SLE patients, which is in the range of 12-40% reported by different prior works [20][21][22].…”

Section: Discussionsupporting

confidence: 64%

Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

Ding¹,

Xiang²,

Zhou³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Risk of infection in SLE is associated with both disease-related and treatment-related factors; high-dose GC therapy, CYC, MMF and RTX are all associated with an increased risk for infection, while high disease activity, severe leucopaenia and presence of renal involvement (±hypogammaglobulinaemia in nephrotic syndrome) also contribute independently 48 140–143. Protection against infections should be proactive, focusing both on primary prevention, as well as timely recognition and treatment.…”

Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

et al. 2019

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Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.

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“…16,17 When SLE concomitantly appears associated to bacterial infections, clinician must have experience in order to differentiate between autoimmune disease activity vs. new activation of the autoimmune disease secondary to infection vs. infection itself. 18,19 Factors that predispose to infections in patients with SLE have been well established and include the use of immunosuppressant, intrinsic dysregulation of the immune system, genetic factors and defects in humoral and cellular immunity, 20,21 so common pathogens as opportunistic infections must always be ruled out. 22 Several publications have demonstrated de relationship between SLE and infection by N. meningitides (Table 4), however, none of these have demonstrated infection of the SNC as a marker of disease onset which could suggest somehow that bacterial infections by this type of Gram negative bacteria would be an initial trigger for the development of SLE in a previously healthy individual.…”

Section: Discussionmentioning

confidence: 99%

Meningococcemia as an initial manifestation of systemic lupus erythematosus

Aponte¹,

Forero²,

Diaz³

et al. 2017

AMJ

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Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

Abstract: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.

Cited by 124 publications

References 54 publications

Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Meningococcemia as an initial manifestation of systemic lupus erythematosus

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