Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Abstract

Objective To evaluate the risk of major infections in children with newly diagnosed childhood-onset systemic lupus erythematosus (cSLE). Methods Predictors of major infections were identified by the multivariable logistic regression. Major infection free was defined as no major infection events within 6 months after the diagnosis of cSLE. The Kaplan–Meier survival plot was performed. A prediction model for major infection events was established and examined by receiver operating characteristic (ROC) curve analysis. Results A total of 98 eligible patients were recorded in the medical charts. Sixty-three documented events of major infections were found in 60 (61.2%) cSLE patients. Furthermore, 90.5% (57/63) of infection events occurred within the first 6 months after the diagnosis of cSLE. The high SLEDAI (SLEDAI >10), lupus nephritis and lymphocyte count <0.8×109/L were predictors for major infections. The CALL score (Children with high disease activity [SLEDAI >10], lymphopenia, and LN) was defined by the number of predictors. Patients were then categorized into two groups: low-risk (score 0–1) and high-risk (score 2–3). Patients in the high-risk group had higher rates of the major infection occurrence than those in the low-risk group during the 6 months after the diagnosis of the cSLE (P<0.001) (HR:14.10, 95% CI 8.43 to 23.59). The ROC curve analysis indicated that the CALL score was effective both in the whole cSLE cohort [area under the curve (AUC) = 0.89, 95% CI: 0.81–0.97] and in the subgroup of lung infections (n = 35) (AUC = 0.79, 95% CI: 0.57–0.99). Conclusion High disease activity, LN and lymphopenia were predictors for major infections in newly diagnosed cSLE patients. Specific predictors help identify the cSLE patients with the high risk of major infections. The CALL score could be a useful tool to stratify cSLE patients in practice.

Addressing Limitations and Enhancing Understanding: Feedback on ‘Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus’ [Letter]

“…I thoroughly reviewed Bao et al’s article 1 on “Major Infections of Childhood-Onset Systemic Lupus Erythematosus” in the Journal of Multidisciplinary Healthcare. This retrospective study analyzed 98 cSLE patients to identify risk factors and develop a prediction model for major infections within 6 months of diagnosis.…”

“…Early identification using the CALL score aids in managing major infections in cSLE patients. 1 The authors acknowledge the retrospective nature of the study, the small number of participants, incomplete or delayed vaccination status, and identifying infections using diagnosis codes as limitations. However, there are additional limitations that should be addressed.…”

“…However, there are additional limitations that should be addressed. 1 The study primarily focused on specific risk factors for major infections in children with systemic lupus erythematosus (cSLE). However, it did not thoroughly examine the impact of underlying comorbidities on the likelihood of contracting an infection.…”

Musculoskeletal symptoms in juvenile onset systemic lupus erythematosus

“…F. Wolfe и соавт. [62] Говоря о скелетно-мышечных проявлениях у пациентов с юСКВ, нельзя не отметить еще один важный аспектвозможность появления подобной симптоматики за счет сопутствующих заболеваний, среди которых важное место занимают инфекции и новообразования [46,70,71]. По данным S. Bao и соавт.…”

“…По данным S. Bao и соавт. [70], риск инфекций, в первую очередь бактериальных, существенно возрастает у детей с юСКВ уже в первые 6 мес после верификации диагноза, ассоциируется с общей высокой активностью заболевания, лимфопенией и поражением почек. В работе Y.F.…”