The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis

Abstract

Objectives We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk. Methods We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster infection/reactivation, opportunistic infections, pneumonia and tuberculosis. Random-effects models were used to calculate pooled risk ratios (RRs) for each type of infection. Sensitivity analysis assessed the impact of removing studies with high risk of bias. Results Eleven retrospective or prospective cohort studies were included in the meta-analysis: overall severe infection (n = 4), pneumonia (n = 6), tuberculosis (n = 3) and herpes zoster (n = 2). Pooled RRs for overall severe infection significantly increased for patients with SLE compared with the general population/healthy controls [RR 2.96 (95% CI 1.28, 6.83)]. Pooled RRs for pneumonia, herpes zoster and tuberculosis showed significantly increased risk compared with the general population/healthy controls [RR 2.58 (1.80, 3.70), 2.50 (2.36, 2.65) and 6.11 (3.61, 10.33), respectively]. Heterogeneity and evidence of publication bias were present for all analyses, except herpes zoster. Sensitivity analyses confirmed robustness of the results. Conclusion Patients with SLE have significantly higher risk of infection compared with the general population/healthy controls. Efforts to strengthen strategies aimed at preventing infections in SLE are needed. Protocol registration PROSPERO number: CRD42018109425.

Increased Oxidative Stress Contributes to Impaired CD56dimCD57+ NK Cells in Patients With Systemic Lupus Erythematosus

“…On the other hand, SLE patients are susceptible to infections which have also been shown to play a role in the development and exacerbation of SLE [2,30,31] . NK cell de ciency and its blunted cytotoxicity function may be an important risk factor for infections in SLE patients, especially the opportunistic infections.…”

“…Systemic lupus erythematosus(SLE) is a multi-organ autoimmune disease driven by aberrant activation of autoreactive T and B cells and the production of autoantibodies [1] . Patients with SLE are known to exhibit diminished antiviral immunity and heightened risk for the development of severe opportunistic infections, which represents an important cause of mortality [2] . NK cells are innate lymphoid cells which mediate resistance against tumor cells and microbial pathogens, especially the virus, and also contribute to regulation of the adaptive immune response [3][4] .…”

Ancestry-based differences in the immune system are associated with lupus severity

“…Lupus patients, speci cally those with heightened disease activity and lupus nephritis, are known to be particularly prone to infections, which are a leading cause of morbidity and mortality in SLE (54)(55)(56). While part of the high infection risk is likely due to immunosuppressive medications, alterations in the immune response due to lupus may also contribute to heightened risk.…”

Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

“…1 2 It is associated with a two-fold to six-fold increase in the risk of infection and a 12-fold increase in the rate of hospitalisation due to serious infectious complications compared with the general population. [3][4][5] Infections account for 13%-37% of hospitalisations and 15.1%-37.5% of deaths in major SLE cohorts. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Patients with SLE have a five times higher risk of death due to infections than the general population.…”