Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort
Journal
Lupus
ISSN
0961-2033
1477-0962
Date Issued
2019
Author(s)
V R Pimentel-Quiroz
M F Ugarte-Gil
GB Harvey
D Wojdyla
G J Pons-Estel
R Quintana
A Esposto
M A García
L J Catoggio
M H Cardiel
L A Barile
M -C Amigo
E I Sato
E Bonfa
E Borba
L T Lavras Costallat
O J Neira
L Massardo
M Guibert-Toledano
R Chacón-Díaz
G S Alarcón
B A Pons-Estel
OSCAR JAVIER NEIRA QUIROGA
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Aim</jats:title><jats:p> The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p < 0.0001) were predictive factors of serious infections. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients. </jats:p></jats:sec>
Subjects
systemic lupus erythematosus
;
serious infections
;
antimalarial use
;
glucocorticoid use
;
adult
;
antimalarials
;
cohort studies
;
dose-response relationship, drug
;
female
;
follow-up studies
;
glucocorticoids
;
hospitalization
;
humans
;
immunosuppressive agents
;
infections
;
latin america
;
lupus erythematosus, systemic
;
male
;
methylprednisolone
;
prednisone
;
protective factors
;
risk factors
;
severity of illness index
;
young adult
;
antimalarial agent
;
azathioprine
;
cyclophosphamide
;
glucocorticoid
;
hydroxychloroquine
;
methylprednisolone
;
prednisone
;
antimalarial agent
;
glucocorticoid
;
immunosuppressive agent
;
methylprednisolone
;
prednisone
;
adult
;
article
;
central nervous system infection
;
cohort analysis
;
controlled study
;
disease activity
;
ethnicity
;
female
;
follow up
;
hospitalization
;
human
;
incidence
;
infection
;
leukopenia
;
lower respiratory tract infection
;
lymphocytopenia
;
major clinical study
;
male
;
marriage
;
predictive value
;
priority journal
;
skin infection
;
sledai
;
social status
;
systemic lupus erythematosus
;
urinary tract infection
;
clinical trial
;
dose response
;
epidemiology
;
etiology
;
multicenter study
;
pathophysiology
;
protection
;
risk factor
;
severity of illness index
;
south and central america
;
systemic lupus erythematosus
;
young adult