title: Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study.
abstract: OBJECTIVE
  Lupus nephritis (LN) is associated with significant morbidity and mortality and hence usually treated aggressively with immunosuppressants. This predisposes LN patients to increased infections, yet few studies have evaluated LN patients for infective complications. We aimed to describe the epidemiology and identify risk factors for infections requiring hospitalization among patients with biopsy-proven LN.
  
  
  METHODS
  This was a single-centre retrospective cohort study of patients with biopsy-proven LN between 1 January 2000 and 31 May 2009. Patients were excluded if they were <16 years old at time of biopsy, had previous kidney transplant or if pharmacotherapy data were incomplete. Hospitalizations for infections, bacteraemia and polymicrobial infections were recorded until patients' last visit or when they received immunosuppression for non-glomerulonephritis indications, such as solid organ transplant or chemotherapy.
  
  
  RESULTS
  We studied 189 patients who had biopsy-proven lupus nephritis. Median age at diagnosis was 36.9 (IQR: 27.4, 47.5) years and 82% were female. Most patients received at least one immunosuppressant after LN diagnosis, including glucocorticosteroids in 94.2%. One hundred and four patients (60.3%) had at least one hospitalization for infection at 11 (1, 53) months from diagnosis. Bacteraemia occurred in 26 patients (13.8%) and 32 patients (16.9%) had polymicrobial infections. On multivariate analysis, LN relapse was associated with hospitalization for infection (OR 2.33 (1.18, 4.60), P = 0.01) and bacteraemia (OR 3.47 (1.05, 11.45), P = 0.04). Infection-related mortality occurred in 10 patients (5.3%).
  
  
  CONCLUSIONS
  Serious infections are common among patients with LN and are associated with mortality.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Pei Yun
authors.initials: PY
authors.lastname: Liu
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Hui Zhuan
authors.initials: HZ
authors.lastname: Tan
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Peishan
authors.initials: P
authors.lastname: Lee
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Yok Mooi
authors.initials: YM
authors.lastname: Chin
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Irene Yj
authors.initials: IY
authors.lastname: Mok
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Choong Meng
authors.initials: CM
authors.lastname: Chan
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Jason Cj
authors.initials: JC
authors.lastname: Choo
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology*; D001706:Biopsy; D060085:Coinfection / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: bacteraemia; immunosuppression; infection; lupus nephritis; systematic lupus erythematosus