Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus.
OBJECTIVE
To describe infectious complications and analyse their risk factors and prognostic role in adults with systemic lupus erythematosus (SLE).


METHODS
A monocentric cohort of 87 adults with SLE (1960-1997) was studied to determine the risk factors for infection (disease activity evaluated by SLAM and SLEDAI scores, type of organ(s) involved or any biological abnormality, specific treatments) by comparing patients who had suffered at least one infectious episode (n=35; 40%) with non-infected patients (n=52; 60%). Prognostic indicators were assessed by comparing survivors at 10 years with non-survivors.


RESULTS
Of the 57 infectious episodes, 47 (82%) were of bacterial origin, 16 (28%) were pneumonia, and 46 (81%) were community acquired. According to univariate analysis, significant risk factors for infection were: severe flares, lupus glomerulonephritis, oral or intravenous corticosteroids, pulse cyclophosphamide, and/or plasmapheresis. No predictors were identified at the time of SLE diagnosis. Multivariate analyses retained intravenous corticosteroids (p<0.001) and/or immunosuppressants (p<0.01) as independent risk factors for infection, which was the only factor for death after 10 years of evolution (p<0.001).


CONCLUSIONS
In adults with SLE, infections are common and most often caused by community acquired bacteria. Intravenous corticosteroids and immunosuppressants are independent risk factors for infection, which is the only independent risk factor for death after 10 years of SLE evolution.
Noël
V
V
Fédération de Médecine Interne, Maladies Infectieuses et Tropicales, Hôpital Avicenne, Université Paris-Nord, Bobigny, France.
Lortholary
O
O
Casassus
P
P
Cohen
P
P
Généreau
T
T
André
M H
MH
Mouthon
L
L
Guillevin
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000150:complications; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D005938:Glucocorticoids; D007166:Immunosuppressive Agents