Predictive potential of the disease activity index and C-reactive protein for infection in systemic lupus erythematosus patients (original) (raw)
Associated clinical factors for serious infections in patients with systemic lupus erythematosus
Scientific Reports, 2019
Infection occurs frequently in patients with systemic lupus erythematosus (sLe), and has been a major cause of morbidity and mortality. However, no large-scale comprehensive studies have estimated the effect of clinical characteristics on serious infection in actual clinical practice yet. We investigated the influence of clinical characteristics on serious infections using electronic medical records data. We conducted a nested case-control study. Patients with SLE who developed serious infection which needs hospitalization or intravenous antibiotics (n = 120) were matched to controls (n = 240) who didn't. Odds ratios (OR) and 95% confidence intervals (CIs) for infection associated with clinical features were obtained by conditional logistic regression analyses. the conditional logistic regression analysis with adjustment showed that serositis (OR, 2.76; 95% CI, 1.33-5.74), hematologic involvement (OR, 2.53; 95% CI, 1.32-4.87), and use of higher than the low dose of glucocorticoids (GCs; >7.5 mg/d prednisolone-equivalent) (OR, 2.65; 95% CI, 1.31-5.34) were related to serious infections in SLE. Serositis, hematologic involvement, and use of higher than the low dose of GCs were associated with serious infections in patients with sLe. Infection is a common and an important morbidity and a significant cause of death in patients with systemic lupus erythematosus (SLE) . The defense immune function of these patients against bacteria, virus, and fungus has been found to be impaired, and opportunistic or serious infections develop frequently. Serious infections requiring hospitalization or intravenous antibiotics injection are associated with mortality and known to occur in 11-45% of patients with SLE 5 . The defective phagocytosis of pathogens, unbalanced levels of pro-and anti-inflammatory cytokines, and lack of complements have been suggested as major causes of vulnerability of patients with SLE to infection . Impaired immune functions cannot control the spread of pathogens and remove pathogens, effectively leading to continuation or worsening of infections. The manifestations and severity of SLE vary depending on the degree of uncontrolled autoimmune response or tissue invasion, which affects defense immunity. Most studies on infection in SLE have found correlations between disease activity markers or manifestations and infections, suggesting that imbalanced immune response with activated autoimmunity contributes to vulnerability of infection . Along with the intrinsic immune deregulations, the susceptibility to infection in terms of treatment also increases. The use of immunosuppressive drugs, including glucocorticoids (GCs), has improved the prognosis of SLE for several decades, making it possible to prevent patients with SLE from developing severe inflammation that either threatens their life or caused organ damage. Although immunosuppressive therapy is effective and essential in controlling disease activity, it has been found to be associated with cardiovascular disease, diabetes, osteoporosis and infection in patients with SLE . The use of GCs has been shown to increase the risk of infection; however, some studies have not found a significant effect of GCs 1,14-19 . Hydroxychloroquine (HCQ) has been revealed to not only control disease activity and prevent flare up or serious manifestations such as nephritis but also to reduce serious infections in SLE . Some studies have analyzed relationships between several immunosuppressive agents and infections in SLE, and concluded that the use of several immunosuppressive agents, such as mycophenolate mofetil, azathioprine, cyclophosphamide, showed no difference in the risk of infection and mortality . Due to these conflicting evidences, the need of clinicians to know what is really happen in real world practice has been increasing.
Predictors of major infections in systemic lupus erythematosus
Arthritis Research & Therapy, 2009
Methods A nested case-control study design was used within the prospective Lupus-Cruces cohort. The endpoints of the study were major infections. Cases were defined as patients with a major infection. Two controls (SLE patients without major infections), matched for time of follow-up until the event and age at diagnosis, were selected for each case. Univariate analysis and logistic regression models were used for the analysis of data.
Factors Related to Infection in Systemic Lupus Erythematosus Patients Admitted to the Hospital
Indonesian Journal of Rheumatology
Background: One of the causes of the increase in hospitalized SLE patients is infection, and it is an important factor in morbidity and mortality, so it is necessary to conduct a research to identify factors related to infection and the type of infection caused in hospitalized SLE patients. Methods: This study is a retrospective, categorical descriptive study utilizing medical records of SLE patients diagnosed with and treated for infection both on admission and during their stay in Hasan Sadikin General Hospital between January 2016 to June 2018. Results: Seventy- four patients were involved into this study. Female were 70 (94.6%), aged <40 years were 69 (93.2%) patients, and all 74 (100%) were entirely in an active disease condition with a mean Mexican systemic lupus erythematosus disease activity (Mex-SLEDAI) score of 9 ± 5.2. Fifty-three (71.6%) subjects experienced major infections. Mucocutaneous and kidney were the most organs involvement found in SLE patients during infect...
Lupus, 2020
Prospective data on infections in systemic lupus erythematosus (SLE) from India are scarce. We studied the frequency and predictors of infections in hospitalized SLE patients. All data on infections were prospectively recorded. During the study period, 212 SLE patients (91% women) were hospitalised. Sixty-three (29.7%) had infections. The most common infections were pneumonia, skin and soft-tissue infections and urinary-tract infections. Mortality was higher in the infection group compared to the no infection group (11.1% vs. 0.7%; p=0.01). At three months, 10/63 developed another episode of infection. On logistic regression, the predictors of infection were fever [odds ratio (OR) = 4.17], vasculitis (OR = 2.64), thrombocytopaenia (OR = 3.59), presence of co-morbidities (OR = 3.59) and duration of hospital stay >11 days (OR = 3.55); p<0.001 for all. High-sensitivity CRP (hsCRP) and procalcitonin were measured in 95 patients. hsCRP was significantly higher in the infection grou...
A study on steroids and immunosuppressants as risk factors for infections in SLE patients
IP innovative publication pvt. ltd, 2019
Introduction: Systemic lupus Erythematosus (SLE) patients are inherently at risk for infections. Steroids and other immunosuppressants used for treating SLE patients further increase the chances of infections. This study was done to find the association of immunosuppressants with the risk of development of infections in patients with SLE. Materials and Methods: Appropriate samples were collected from 110 SLE patients with various infections and processed in Microbiology laboratory. Treatment history was also collected from the patients and analysis was done on infections in these patients. Results: Daily prednisolone dosage 20 mg was associated with increased risk of infection with p value of < 0.05 and in patients receiving Cyclophosphamide with steroids also risk of infection was higher with p value <0.05 which is also statistically significant. Conclusion: Since there is strong association between higher dose of steroids and Cyclophosphamide therapy with risk of infections in SLE patients, judicious use of these drugs is recommended.
Annals of the Rheumatic Diseases, 1980
The concentration of C-reactive protein (CRP) in the sera of patients with systemic lupus erythematosus (SLE) was higher when the disease was active than when it was inactive, but was only markedly raised in patients suffering from identifiable microbial infection. CRP levels greater than 60 mg/i suggest the presence of intercurrent infection and may therefore be a valuable aid to the differential diagnosis of pyrexia in SLE. Pyrexia in systemic lupus erythematosus SLE is a common and important clinical problem (Hughes, 1977), particularly in patients who are being treated with anti-inflammatory or immunosuppressive drugs. The differential diagnosis, which usually lies between intercurrent infection and simple exacerbation of the underlying disease, may often be difficult to resolve rapidly. The erythrocyte sedimentation rate (ESR) is not a good index of disease activity in SLE (Hughes, 1977). Although the ESR does tend to rise with intercurrent infection, this does not differentiate it from active SLE alone with high ESR. Furthermore plasma viscosity and to an even greater extent ESR are determined by many variables and respond rather slowly and very variably to alterations in disease activity and other stimuli (Pepys, 1979a). Patients and methods Forty-one patients fulfilling the American Rheumatology Association criteria for the classification of SLE were studied longitudinally with a total of 214 sera collected over the 24-month period prior to June 1978. Their disease was regarded as active if vasculitis, serositis, arthritis, cerebral lupus, or severe glomerulonephritis was present. Infection was diagnosed only when clinical evidence was supported by microbiological studies. Patients with mild
Distinguishing infectionsvsflares in patients with systemic lupus erythematosus: Table 1
Rheumatology, 2016
SLE is a chronic autoimmune disease involving multiple systems. Patients with SLE are highly susceptible to infections due to the combined effects of their immunosuppressive therapy and the abnormalities of the immune system that the disease itself causes, which can increase mortality in these patients. The differentiation of SLE activity and infection in a febrile patient with SLE is extremely difficult. Activity indexes are useful to identify patients with lupus flares but some clinical and biological abnormalities may, however, make it difficult to differentiate flares from infection. Several biological markers are now recognized as potential tools to establish the difference between SLE activity and infection, including CRP and procalcitonin. It is possible, however, that the use of only one biomarker is not sufficient to confirm or discard infection. This means that new scores, which include different biomarkers, might represent a better solution for differentiating these two clinical pictures. This review article describes several markers that are currently used, or have the potential, to differentiate infection from SLE flares.
Seminars in arthritis and rheumatism, 2017
To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. 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. 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 tim...