Ana Rita Prata1, Mariana Luís2,3, Helena Assunção2, José António Pereira da Silva2,3, Luís Sousa Inês2,4. 1. Rheumatology Unit, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. anaritaprata@gmail.com. 2. Rheumatology Unit, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 3. Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 4. Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
Abstract
INTRODUCTION/ OBJECTIVES: Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE. METHOD: We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed. RESULTS: We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26-3.03) and female gender (HR = 2.08, 95%CI 1.12-3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39-13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06-0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04-3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21-2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26-0.93) and female gender (HR = 5.12; 95%CI 1.62-16.18) with higher risk of bacterial infection. CONCLUSIONS: The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection. Key Points • Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections. • Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections. • Lupus patients receiving antimalarials were 82% less likely to present serious infections.
INTRODUCTION/ OBJECTIVES: Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE. METHOD: We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed. RESULTS: We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26-3.03) and female gender (HR = 2.08, 95%CI 1.12-3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39-13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06-0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04-3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21-2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26-0.93) and female gender (HR = 5.12; 95%CI 1.62-16.18) with higher risk of bacterial infection. CONCLUSIONS: The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection. Key Points • Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections. • Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections. • Lupus patients receiving antimalarials were 82% less likely to present serious infections.
Authors: Íñigo Rúa-Figueroa; Javier López-Longo; María Galindo-Izquierdo; Jaime Calvo-Alén; Víctor Del Campo; Alejandro Olivé-Marqués; Sabina Pérez-Vicente; Antonio Fernández-Nebro; Mariano Andrés; Celia Erausquin; Eva Tomero; Loreto Horcada; Esther Uriarte; Mercedes Freire; Carlos Montilla; Ana Sánchez-Atrio; Gregorio Santos; Alina Boteanu; Elvira Díez-Álvarez; Javier Narváez; Víctor Martínez-Taboada; Lucía Silva-Fernández; Esther Ruiz-Lucea; José Luis Andreu; José Ángel Hernández-Beriain; Marian Gantes; Blanca Hernández-Cruz; José Pérez-Venegas; Ángela Pecondón-Español; Carlos Marras; Mónica Ibáñez-Barceló; Gema Bonilla; Vicente Torrente; Iván Castellví; Juan José Alegre; Joan Calvet; Jose Luis Marenco; Enrique Raya; Tomás Vázquez; Victor Quevedo; Santiago Muñoz-Fernández; Manuel Rodríguez-Gómez; Jesús Ibáñez; José M Pego-Reigosa Journal: Semin Arthritis Rheum Date: 2017-01-27 Impact factor: 5.532
Authors: V Noël; O Lortholary; P Casassus; P Cohen; T Généreau; M H André; L Mouthon; L Guillevin Journal: Ann Rheum Dis Date: 2001-12 Impact factor: 19.103
Authors: Helena Assunção; Marília Rodrigues; Ana Rita Prata; Mariana Luís; José A P da Silva; Luís Inês Journal: Clin Rheumatol Date: 2022-06-23 Impact factor: 3.650