Infectious processes and systemic lupus erythematosus

Illescas‐Montes, Rebeca; Corona‐Castro, Claudia Cristina; Melguizo‐Rodríguez, Lucia; Ruíz, Concepción; Costela‐Ruiz, Víctor J.

doi:10.1111/imm.13103

Cited by 103 publications

(70 citation statements)

References 26 publications

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“…Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of an unknown etiology [1]. The long-term survival of SLE has markedly improved over the past decades [2], but the risk of premature death has plateaued since 1999 [3] and considerable morbidity continues to afflict affected patients [4].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

Oud

2020

j intensive care

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Background: Sepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. However, there are no population-level data on the patterns of the demand for critical care services among hospitalized septic patients with SLE or the outcomes of those admitted to the ICU. Methods: We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File, to identify SLE hospitalizations aged ≥ 18 years and the subgroups with sepsis and ICU admission during 2009-2014. The patterns of ICU admission among septic hospitalizations were examined. Logistic regression modeling was used to identify predictors of short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions with sepsis and to estimate the risk-adjusted short-term mortality among ICU admissions with and without sepsis. Results: Among 94,338 SLE hospitalizations, 17,037 (18.1%) had sepsis and 9409 (55.2%) of the latter were admitted to the ICU. Sepsis accounted for 51.5% of the growth in volume of ICU admissions among SLE hospitalizations during the study period. Among ICU admissions with sepsis, 25.3% were aged ≥ 65 years, 88.6% were female, and 64.4% were non-white minorities. The odds of short-term mortality among septic ICU admissions were increased among those lacking health insurance (adjusted odds ratio 1.40 [95% confidence interval 1.07-1.84]), while being unaffected by gender and race/ethnicity, and remaining unchanged over the study period. On adjusted analyses among ICU admissions, the short-term mortality among those with and without sepsis was 13% (95% CI 12.6-13.3) and 2.7% (95% CI 2.6-2.8), respectively. Sepsis was associated with 63.6% of all short-term mortality events. Conclusions: Sepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE.

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Section: Introductionmentioning

confidence: 99%

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

Oud

2020

j intensive care

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“…The etiology of SLE is unknown, although both exogenous and endogenous factors have been found to in uence its pathogenesis, with infectious agents playing an important role in genetically predisposed individuals [5]. Various pathogens have been implicated in the development of SLE, especially viruses such as human endogenous retroviruses, Epstein-Barr virus, parvovirus B19, cytomegalovirus and human immunode ciency virus type 1 [6].…”

Section: Introductionmentioning

confidence: 99%

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Gracia‐Ramos¹,

Saavedra-Salinas²

2020

Preprint

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Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic chronic inflammatory disease that can affect various organs, including skin, joints, kidneys, lungs and the nervous system. Infectious agents have long been implicated in the pathogenesis of SLE. The new viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown that, in genetically predisposed patients, could trigger the presentation or exacerbation of autoimmune disease. We herein report a case of a 45-year-old man who presented respiratory symptoms, bilateral pleural effusion, ascites, splenomegaly, severe thrombocytopenia and renal failure with proteinuria and hematuria. SARS-CoV-2 PCR confirmed the COVID-19 diagnosis. We diagnosed the patient with SLE based on the clinical manifestations and positive immunological markers (2019 European League Against Rheumatism/American College of Rheumatology score of 18). Glucocorticoid pulses were administered to the patient with improvement in renal function. However, thrombocytopenia was also refractory to IV immunoglobulin and rituximab, so the patient underwent splenectomy. Through a systematic search of the medical literature, we retrieved 2 cases with SLE new onset and 5 cases with previous SLE diagnosis that shown activity of disease due SARS-CoV-2 infection. We herein present a systemic review of these cases and discuss the clinical manifestations that could help to the diagnosis of this clinical condition.

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“…Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of an unknown etiology [ 1 ]. Although the long-term survival of SLE has progressively improved over the past decades [ 2 ], the risk of premature death has plateaued since 1999 [ 3 ] and patients continue to be affected by considerable morbidity [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study

Oud

2020

J Clin Med Res

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Background Hospitalized patients with systemic lupus erythematosus (SLE) often require critical care, and SLE is the most common autoimmune disease in the intensive care unit (ICU). Mental disorders are highly prevalent among patients with SLE and are associated with increased morbidity and premature death in this population. However, the association of mental disorders with ICU utilization among patients with SLE and their prognostic impact among those admitted to ICU is unknown. Methods We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File to identify SLE hospitalizations aged ≥ 18 years during 2009 - 2014. Mental disorders were defined by the taxonomy of the Healthcare Cost and Utilization Project’s Clinical Classification Software Category 5. The patterns of ICU admission among SLE hospitalizations with and without mental disorders were examined. Multivariable logistic regression modeling was used to examine the association of mental disorders and short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions. Results Among 94,338 SLE hospitalizations 35,793 (37.9%) had mental disorders. There was no difference in the rates of ICU admission among SLE hospitalizations with and without mental disorders (37% vs. 37.2%, respectively; P = 0.5999), and similar rates of mental disorders were found among SLE hospitalizations with and without ICU admission (37.8% vs. 38%, respectively; P = 0.5408). The volume of SLE ICU admissions with and without mental disorders rose between 2009 and 2014 by 60.3% vs. 7.9%, respectively. When compared to those without mental disorders, SLE ICU admissions with mental disorders were older (age ≥ 65 years, 23.6% vs. 21.4%, respectively) and had higher burden of comorbid conditions. Unadjusted short-term mortality among SLE ICU admissions with and without mental disorders was 4.8% and 5.8%, respectively and mental disorders were associated with lower short-term mortality on adjusted analyses (adjusted odds ratio (aOR): 0.826; 95% confidence interval (CI): 0.734 - 0.930). Conclusions There was no difference in the frequency of mental disorders among hospitalized patients with SLE with and without ICU admission. However, the growth in the volume of ICU admissions with SLE over time involved predominantly patients with mental disorders. Among ICU admissions, mental disorders were associated with lower short-term mortality.

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Infectious processes and systemic lupus erythematosus

Cited by 103 publications

References 26 publications

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study

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