Influenza infection as a trigger for systemic lupus erythematosus flares resulting in hospitalization

Abstract

In patients with systemic lupus erythematosus (SLE), there are concerns that infections may increase the risk of flares. We evaluated the association between influenza infection and SLE flares resulting in hospitalization. SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model. We identified 1624 influenza infections among the 1455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63-37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00-37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively). We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.

Figure 1

Patient selection flow chart. SLE systemic lupus erythematosus.

Figure 2

Study design. This study was conducted using the self-controlled case series design. The index date of influenza infection is the first day to be prescribed oseltamivir phosphate. The number of SLE flares resulting in hospitalization are counted on a yearly (52 weeks) basis. Risk interval was defined as the first 7 days from the index date of influenza infection. The control interval was defined as all other times during the observation period of each influenza season. SLE systemic lupus erythematosus.