title: Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study.
abstract: BACKGROUND
  Infections are a major cause of morbidity in patients with systemic lupus erythematosus (SLE), and may lead to death. No nationally representative study of patients with SLE has examined the rates of infection-related hospitalization and the risk of end-stage renal disease (ESRD).
  
  
  METHODS
  We conducted a nationwide cohort study of 7326 patients with newly diagnosed SLE and no history of ESRD. All data were from Taiwan's National Health Insurance claims database for the period 2000-11.
  
  
  RESULTS
  Among all SLE patients, 316 (4.3%) developed ESRD (mean follow-up time: 8.1 years). Multivariate Cox regression analysis indicated that the risk of ESRD increased with the number of infection-related hospitalizations. For patients with three or more infection-related admissions, the hazard ratio (HR) for ESRD was 5.08 [95% confidence interval (CI): 3.74-6.90] relative to those with no infection-related admission. Analysis by type of infection indicated that bacteremia patients had the greatest risk for ESRD (HR: 4.82; 95% CI: 3.40-6.85). Analysis of age of SLE onset indicated that patients with juvenile-onset (<18 years) and three or more infection-related hospitalizations had a greatly increased risk for ESRD (HR: 14.49; 95% CI: 5.34-39.33).
  
  
  CONCLUSIONS
  Infection-related hospitalizations are associated with a significantly increased risk of ESRD in patients with SLE, especially those with juvenile-onset SLE. Among patients with different types of infectious diseases, those with bacteremia were more likely to develop ESRD.
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Pediatrics, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chia-yi Christian Hospital, Chia-yi, Taiwan.|Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.affiliation: Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hu
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yann-Jang
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001424:Bacterial Infections / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
keywords: National Health Insurance; end-stage renal disease; hospitalization; infection; systemic lupus erythematosus