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

2017; Elsevier BV; Volume: 47; Issue: 1 Linguagem: Inglês

10.1016/j.semarthrit.2017.01.010

1532-866X

Íñigo Rúa‐Figueroa, J. Lόpez-Longo, María Galindo, Jaime Calvo‐Alén, Víctor del Campo, Alejandro Olivé-Marqués, Sabina Pérez-Vicente, Antonio Fernández‐Nebro, Mariano Andrés, Celia Erausquin, Eva Tomero, Loreto Horcada, E. Uriarte, Mercedes Freire, Carlos Montilla, Ana Sánchez-Atrio, GABRIELLE ALMEIDA SANTOS, Alina Boteanu, Elvira Díez‐Álvarez, Javier Narváez, Víctor M. Martínez-Taboada, Lucía Silva-Fernández, Esther Ruiz-Lucea, José Luís Andreu, José Ángel Hernández-Beriaín, M. Gantes, Blanca Hernández‐Cruz, J.J. Pérez-Venegas, Ángela Pecondón-Español, Carlos Marras, Mónica Ibáñez‐Barceló, Gema Bonilla, V. Torrente, I. Castellví, Juan José Alegre Sancho, Joan Calvet, José Luis Marenco, Enrique Raya, Tomás Vázquez, Víctor Quevedo, Santiago Muñoz‐Fernández, Manuel Romero‐Gómez, J. Ibañez, José María Pego‐Reigosa,

Diabetes and associated disorders

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 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).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.