Major infections in newly diagnosed systemic lupus erythematosus: an inception cohort study

Wang, Haiting; Zhou, Yuhong; Yu, Lei; Wu, Wanlong; Zhao, Liling; Geng, Shikai; Sun, Fangfang; Zhang, Danting; Shen, Nan; Chen, Yi; Ye, Shuang

doi:10.1136/lupus-2022-000725

Cited by 8 publications

(22 citation statements)

References 25 publications

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“…Escherichia coli , Klebsiella pneumoniae , and Pseudomonas aeruginosa were the other commonly isolated Gram-negative bacteria. This is similar to data from China and Mexico (Table 1 ) [ 10 , 25 ].…”

Section: Discussionsupporting

confidence: 89%

“…Most of these factors also predicted infection in our cohort. Other factors associated with serious infection across studies include serositis, renal involvement, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, low C3, and the presence of diabetes (Table 5 ) [ 5 , 10 , 15 , 16 , 20 , 25 , 43 ]. Increasing daily corticosteroid dose and immunosuppressants such as cyclophosphamide, mycophenolate mofetil, and rituximab were also predictors of infection whereas cumulative use of hydroxychloroquine was protective [ 15 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, at presentation clinical manifestations were as follows: fever (1004, 74.2%), mucocutaneous (941, 69.5%), arthritis (831, 62.9%), myositis (120, 8.9%), hematological (578, 42.7%), serositis (218, 16.1%), nephritis (656, 48.4%), respiratory (34, 2.5%), cardiovascular (42, 3.1%), neuropsychiatric (142, 10.5%), gastrointestinal (30, 2.2%), vasculitis (65, 4.8%), and secondary anti-phospholipid antibody syndrome (APS) (114, 8.4%). The median SLE-DAI-2 K score at presentation was 11 (8)(9)(10)(11)(12)(13)(14)(15)(16). Four percent of patients were diabetic.…”

Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

“…1). (22), disseminated (11), central nervous system (10), lymph node (9), abdomen (8), joint (8), spine (3), pleural effusion (2), pericarditis (2), hepatitis (2), skin (1), abscess (1), osteomyelitis (1), tenosynovitis (1) Mycobacterium abscessus 1 Eschericia coli 51 715.5 Sepsis (20), pyelonephritis (14), cystitis θ (7), pneumonia (6), spontaneous bacterial peritonitis (2), abscess (2) Staphylococcus aureus 65 911.9 Abscess (30), pneumonia (12), sepsis (11), cellulitis (7), meningitis (2), brain abscess (1), muscle (1)…”

Section: Time Trend Of Serious Infectionsmentioning

confidence: 99%

“…Although overall mortality in SLE has improved over the last few decades with advances in immunosuppressive therapy, early mortality due to infections still persists with serious infection conferring a 22 times higher odds of mortality in the first year of disease [ 10 ]. Infection attributable mortality of 25% has been previously reported from a European cohort [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Introduction Infections are a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in SLE in India. Methods A retrospective review of a cohort of 1354 patients of adult SLE (ACR 1997 criteria) seen between 2000 and 2021 at a single center was conducted. Serious infections (need for hospitalisation, prolonged intravenous antibiotics, disability, or death) were recorded. Cox regression was used to determine factors associated with serious infection and the effects of serious infection on survival and damage. Results Among the 1354 patients (1258 females, mean age of 30.3 years, follow-up of 7127.89 person-years), there were 439 serious infections in 339 patients (61.6 per 1000 person-years follow-up). Bacterial infections ( N = 226) were the most common infection followed by mycobacterial infections ( n = 81), viral ( n = 35), and then invasive fungal infections ( N = 13). Mycobacterium tuberculosis was the single most common microbiologically confirmed organism with incidence of 1136.4/100,000 person-years with 72.8% of them being extrapulmonary. Infection free survival at 1 year and 5 years was 82.9% and 73.8%. There were 119 deaths with infection attributable mortality in 65 (54.6%). On multivariable Cox regression analysis, higher baseline activity (HR 1.02, 1.01–1.05), gastrointestinal involvement (HR 2.75, 1.65–4.69), current steroid dose (HR 1.65, 1.55–1.76), and average cumulative steroid dose per year (HR 1.007, 1.005–1.009) were associated with serious infection and higher albumin (HR 0.65, 0.56–0.76) was protective. Serious infections led to greater damage accrual (median SLICC damage index of 1 vs. 0) and mortality (HR was 18.2, 32.7 and 81.6 for the first, second, and third infections). Conclusion Serious infections remain a major cause of mortality and damage accrual in SLE and higher disease activity, gastrointestinal involvement, hypoalbuminemia, current steroid dose, and cumulative steroid dose are the risk factors for it. Key Points • Tuberculosis is still a major cause of morbidity in South Asian patients of SLE. • Serious infections are associated with higher damage accrual and mortality in patients with SLE. • Higher disease activity, gastrointestinal involvement, hypoalbuminemia, and current steroid dose were associated with increased risk of infection. • This study provides data to enable specific recommendations for infection prevention in SLE for the South Asian region. Supplementary information The online version contains supplementary material available at 10.1007/s10067-023-06592-x.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

Section: Time Trend Of Serious Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Systemic lupus erythematosus: latest insight into etiopathogenesis

et al. 2023

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Systemic lupus erythematosus (SLE) is a complex autoimmune disorder of unknown etiology. Multifactorial interaction among various susceptible factors such as environmental, hormonal, and genetic factors makes it more heterogeneous and complex. Genetic and epigenetic modifications have been realized to regulate the immunobiology of lupus through environmental modifications such as diet and nutrition. Although these interactions may vary from population to population, the understanding of these risk factors can enhance the perception of the mechanistic basis of lupus etiology. To recognize the recent advances in lupus, an electronic search was conducted among search engines such as Google Scholar and PubMed, where we found about 30.4% publications of total studies related to genetics and epigenetics, 33.5% publications related to immunobiology and 34% related to environmental factors. These outcomes suggested that management of diet and lifestyle have a direct relationship with the severity of lupus that influence via modulating the complex interaction among genetics and immunobiology. The present review emphasizes the knowledge about the multifactorial interactions between various susceptible factors based on recent advances that will further update the understanding of mechanisms involved in disease pathoetiology. Knowledge of these mechanisms will further assist in the creation of novel diagnostic and therapeutic options.

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Características sociodemográficas, clínicas y bioquímicas de pacientes que debutaron con y sin nefritis lúpica en una cohorte de pacientes mexicanos con lupus eritematoso sistémico en un centro de referencia

Pazos-Pérez,

Martínez-Badajoz,

Bravo-Rojas

et al. 2024

Revista Colombiana de Reumatología

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Major infections in newly diagnosed systemic lupus erythematosus: an inception cohort study

Cited by 8 publications

References 25 publications

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

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

Systemic lupus erythematosus: latest insight into etiopathogenesis

Características sociodemográficas, clínicas y bioquímicas de pacientes que debutaron con y sin nefritis lúpica en una cohorte de pacientes mexicanos con lupus eritematoso sistémico en un centro de referencia

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