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Meta-Analysis
. 2021 Jan 5;60(1):60-72.
doi: 10.1093/rheumatology/keaa478.

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

José María Pego-Reigosa  1   2 , Lindsay Nicholson  3 , Nick Pooley  3 , Sue Langham  4 , Nina Embleton  5 , Zoe Marjenberg  3 , Volkan Barut  6 , Barnabas Desta  7 , Xia Wang  8 , Julia Langham  9 , Edward R Hammond  10
Affiliations
Meta-Analysis

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

José María Pego-Reigosa et al. Rheumatology (Oxford). .

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.

Keywords: SLE; herpes zoster; infection; meta-analyses; pneumonia; tuberculosis.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Flow diagram of the systematic literature review process
<sc>Fig</sc>. 2
Fig. 2
Forrest plots: meta-analyses of risk of overall severe infection, pneumonia, herpes zoster and tuberculosis in SLE RE: random effects.
See this image and copyright information in PMC

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