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Semin Arthritis Rheum. 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.

Author information

1
Rheumatology Department, Doctor Negrín University Hospital Las Palmas de Gran Canaria, Bco. de la Ballena s/n, 35020 Las Palmas, Spain. Electronic address: iruafer@gobiernodecanarias.org.
2
Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain.
3
Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain.
4
Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain.
5
Preventive Medicine Service, Biomedical Research Institute of Vigo (IBIV), University Hospital Complex of Vigo, Vigo, Spain.
6
Rheumatology Department, German Trials i Pujol Hospital, Badalona, Spain.
7
Statistical Department, Research Unit, Spanish Society of Rheumatology (SER), Madrid, Spain.
8
Rheumatology Department, Carlos Haya University Hospital, Málaga, Spain.
9
Rheumatology Department, Hospital of Alicante, Alicante, Spain.
10
Rheumatology Department, Doctor Negrín University Hospital Las Palmas de Gran Canaria, Bco. de la Ballena s/n, 35020 Las Palmas, Spain.
11
Rheumatology Department, La Princesa University Hospital, Madrid, Spain.
12
Rheumatology Department, Hospital of Navarra, Pamplona, Spain.
13
Rheumatology Department, Donostia Hospital, Donostia, Guipuzcoa, Spain.
14
Rheumatology Department, University Hospital Complex of A Coruña, A Coruña, Spain.
15
Rheumatology Department, Salamanca University Hospital, Salamanca, Spain.
16
System Diseases and Oncology Service, Príncipe de Asturias University Hospital Alcalá de Henares, Madrid, Spain.
17
Rheumatology Department, Marina Baixa Hospital, Alicante, Spain.
18
Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain.
19
Rheumatology Department, Hospital of León, León, Spain.
20
Rheumatology Department, Bellvitge Hospital, Barcelona, Spain.
21
Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain.
22
Rheumatology Department, University Hospital Complex of Ferrol, Ferrol, Spain.
23
Rheumatology Department, Basurto Hospital, Bilbao, Spain.
24
Rheumatology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain.
25
Rheumatology Department, Hospital Insular of Gran Canaria, Las Palmas de Gran Canaria, Spain.
26
Rheumatology Department, University Hospital of Canarias, Tenerife, Spain.
27
Rheumatology Department, Virgen Macarena Hospital, Sevilla, Spain.
28
Rheumatology Department, Jerez de la Frontera University Hospital, Cádiz, Spain.
29
Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain.
30
Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain.
31
Rheumatology Department, Son Llatzer Hospital, Mallorca, Spain.
32
Rheumatology Department, La Paz University Hospital, Madrid, Spain.
33
Rheumatology Department, Hospital of Hospitalet-Moisés Broggi CSI, Barcelona, Spain.
34
Rheumatology Unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain.
35
Rheumatology Department, Dr. Peset Hospital, Valencia, Spain.
36
Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain.
37
Rheumatology Department, Virgen de Valme University Hospital, Sevilla, Spain.
38
Rheumatology Department, San Cecilio Hospital, Granada, Spain.
39
Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain.
40
Rheumatology Unit, Monforte Hospital, Lugo, Spain.
41
Rheumatology Department, Infanta Sofía University Hospital, Madrid, Spain.
42
Rheumatology Department, Hospital Complex of Ourense, Orense, Spain.
43
Rheumatology Unit, POVISA Medical Center, Vigo, Spain.
44
Rheumatology Department, Biomedical Research Institute of Vigo (IBIV), University Hospital Complex of Vigo, Vigo, Spain.

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

[Indexed for MEDLINE]

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