title: Clinical and immunogenetic factors associated with pneumonia in patients with systemic lupus erythematosus: a case-control study.
abstract: OBJECTIVE
  To determine the incidence of pneumonia and associated factors in a single-center systemic lupus erythematosus (SLE) cohort.
  
  
  METHODS
  We included all our SLE patients [1997 American College of Rheumatology (ACR) criteria] with ≥ 1 pneumonia event, and 196 age and sex-matched SLE controls with no pneumonia events. Cumulative clinical data, weighted Systemic Lupus International Collaborating Clinics/ACR damage index (wSLICC/ACR-DI), comorbidities, and risk factors for pneumonia were retrospectively collected. The standardized incidence ratio (SIR) of pneumonia was estimated. Polymorphisms at genes coding for mannose binding lectin (MBL), MBL-associated serine protease 2, Fc-gamma receptors, and surfactant proteins A1, A2, and D were determined, and their potential association with pneumonia was analyzed. Patients with and without pneumonia were compared using a multivariate logistic regression model for adjustment of pneumonia-associated factors.
  
  
  RESULTS
  Thirty-six of 232 patients with SLE had experienced ≥ 1 pneumonia event. SIR for pneumonia was 5.1 (95% CI 3.5-7.4; p < 0.0001). Excluding patients receiving immunosuppressive therapy at the time of pneumonia (13%), associations were found for Katz Severity Index (KSI) (p = 0.016), wSLICC/ACR-DI (p = 0.044), number of SLE criteria (p = 0.005), hospital admissions (p < 0.001), FCGR2A HH genotype (p = 0.03), previous use of immunosuppressive therapy (p = 0.049), cutaneous ulcers (p < 0.001), and vasculitis (p = 0.008) in bivariate analyses. In the multivariate analysis adjusted to previous immunosuppressive treatment, only KSI and FCGR2A HH genotype remained statistically significant (p = 0.05 and p = 0.03, respectively).
  
  
  CONCLUSIONS
  The incidence of pneumonia in patients with SLE is higher than that in the general population, and particularly high in severe SLE, regardless of immunosuppressive therapy. The HH genetic variant of FCGR2A appears to predispose patients with SLE to pneumonia.
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín. iruafer@gobiernodecanarias.org.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Rúa-Figueroa
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Javier
authors.initials: J
authors.lastname: Nóvoa
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: García-Laorden
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Celia
authors.initials: C
authors.lastname: Erausquin
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Miguel
authors.initials: M
authors.lastname: García-Bello
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodríguez de Castro
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Herrera-Ramos
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Quevedo
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Félix
authors.initials: F
authors.lastname: Francisco
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Antonio
authors.initials: A
authors.lastname: Naranjo
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Lozano
authors.affiliation: From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Gallego
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D007125:Immunogenetics; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology / Q000235:genetics* / Q000276:immunology; D008297:Male; D037601:Mannose-Binding Lectin / Q000235:genetics; D050606:Mannose-Binding Protein-Associated Serine Proteases / Q000235:genetics; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000235:genetics* / Q000276:immunology; D037662:Pulmonary Surfactant-Associated Protein A / Q000235:genetics; D037663:Pulmonary Surfactant-Associated Protein D / Q000235:genetics; D017452:Receptors, IgG / Q000235:genetics; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D037601:Mannose-Binding Lectin; D037662:Pulmonary Surfactant-Associated Protein A; D037663:Pulmonary Surfactant-Associated Protein D; D017452:Receptors, IgG; C105296:MASP2 protein, human; D050606:Mannose-Binding Protein-Associated Serine Proteases
keywords: IMMUNOGENETICS; LUPUS; PNEUMONIA