Severe infections in systemic lupus erythematosus: disease pattern and predictors of infection-related mortality.
Infection is a major cause of morbidity and mortality among patients with systemic lupus erythematosus (SLE). To describe the pattern of serious infections in patients with SLE and to identify the predictors of infection-related mortality among SLE patients with serious infections, we prospectively studied all SLE patients who were hospitalized with infections in Sarawak General Hospital during 2011-2015. Demographic data, clinical features, and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of infection-related mortality. There were a total of 125 patients with 187 episodes of serious infections. Our patients were of multiethnic origins with female predominance (89.6%). Their mean age was 33.4 ± 14.2 years. The patients had a mean disease duration of 66.8 ± 74.0 months. The most common site of infection was pulmonary (37.9%), followed by septicemia (22.5%). Gram-negative organisms (38.2%) were the predominant isolates within the cohort. There were 21 deaths (11.2%) during the study period. Independent predictors of infection-related mortality among our cohort of SLE patients were flare of SLE (HR 3.98, CI 1.30-12.21) and the presence of bacteremia (HR 2.54, CI 0.98-6.59). Hydroxychloroquine was protective of mortality from serious infections (HR 9.26, CI 3.40-25.64). Pneumonia and Gram-negative organisms were the predominant pattern of infection in our SLE cohort. The presence of flare of SLE and bacteremia were independent prognostic predictors of infection-related mortality, whereas hydroxychloroquine was protective of infection-related mortality among SLE patients with serious infections.
['Teh|C L|CL|http://orcid.org/0000-0001-7897-3994', 'Wan|S A|SA|', 'Ling|G R|GR|']
D000328:Adult D001424:Bacterial Infections D002177:Candidiasis D004791:Enzyme Inhibitors D005260:Female D006562:Herpes Zoster D006760:Hospitalization D006801:Humans D006886:Hydroxychloroquine D007166:Immunosuppressive Agents D008180:Lupus Erythematosus, Systemic D008296:Malaysia D008297:Male D008875:Middle Aged D011446:Prospective Studies D062606:Tertiary Care Centers D055815:Young Adult
Infection Systemic lupus erythematosus Mortality