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Multicenter Study
. 2017 Aug;47(1):38-45.
doi: 10.1016/j.semarthrit.2017.01.010. Epub 2017 Jan 27.

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

Íñigo Rúa-Figueroa  1 , Javier López-Longo  2 , María Galindo-Izquierdo  3 , Jaime Calvo-Alén  4 , Víctor Del Campo  5 , Alejandro Olivé-Marqués  6 , Sabina Pérez-Vicente  7 , Antonio Fernández-Nebro  8 , Mariano Andrés  9 , Celia Erausquin  10 , Eva Tomero  11 , Loreto Horcada  12 , Esther Uriarte  13 , Mercedes Freire  14 , Carlos Montilla  15 , Ana Sánchez-Atrio  16 , Gregorio Santos  17 , Alina Boteanu  18 , Elvira Díez-Álvarez  19 , Javier Narváez  20 , Víctor Martínez-Taboada  21 , Lucía Silva-Fernández  22 , Esther Ruiz-Lucea  23 , José Luis Andreu  24 , José Ángel Hernández-Beriain  25 , Marian Gantes  26 , Blanca Hernández-Cruz  27 , José Pérez-Venegas  28 , Ángela Pecondón-Español  29 , Carlos Marras  30 , Mónica Ibáñez-Barceló  31 , Gema Bonilla  32 , Vicente Torrente  33 , Iván Castellví  34 , Juan José Alegre  35 , Joan Calvet  36 , Jose Luis Marenco  37 , Enrique Raya  38 , Tomás Vázquez  39 , Victor Quevedo  40 , Santiago Muñoz-Fernández  41 , Manuel Rodríguez-Gómez  42 , Jesús Ibáñez  43 , José M Pego-Reigosa  44
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Free article
Multicenter Study

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

Íñigo Rúa-Figueroa et al. Semin Arthritis Rheum. 2017 Aug.
Free article

Abstract

Objectives: To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort.

Methods: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection.

Results: A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999).

Conclusions: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.

Keywords: Antimalarials; Infection; Systemic lupus erythematosus.

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