title: The risk of tuberculosis in SLE patients from an Asian tertiary hospital.
abstract: Systemic lupus erythematosus (SLE) has been associated with increased risk of tuberculosis (TB). However, little is known about the extent and risk factors for TB among Asian patient with SLE. We aimed to assess the rate of TB in patients with SLE, and investigate the risk of SLE on TB development using hospital administrative database. This is an historical cohort study of hospital discharge database from 2004 to 2011 to identify cases with SLE and TB using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. Of 301568 hospitalized patients, 841 (0.3%) patients had SLE, 1843 (0.6%) patients had TB, including 17 SLE patients (2.0%). SLE patients had a significantly higher rate of TB (2.0 vs. 0.6%, p < 0.001) compared to that of patients without SLE. The differences in the higher rate after breaking down was in the pulmonary TB group (1.7 vs. 0.5%, p < 0.00) but not in extrapulmonary TB group (0.4 vs. 0.1%, p = 0.060). Logistic regression analyses showed that SLE was a significant and independent predictor of TB (odds ratio 4.6, 95% CI 2.8-7.5, p < 0.001) after adjustment for factors such as age group, gender, ethnicity, admission class, nutritional deficiency, organ transplantation, and Charlson comorbidity index. SLE patients were found to experience higher rates of tuberculosis in this group of Asian patient population. Patients with SLE should be considered as a high-risk group for TB, active screening for latent patients and treatment for positive TB patients is needed.
authors.affiliation: Department of Epidemiology, Medical Board, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. yang.yong@sgh.com.sg.|Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. yang.yong@sgh.com.sg.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.|Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.affiliation: Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.|Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Ban Hock
authors.initials: BH
authors.lastname: Tan
authors.affiliation: Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.|Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Thuan Tong
authors.initials: TT
authors.lastname: Tan
authors.affiliation: Healthcare Analytics, Integrated Health Information Systems (IHIS), SingHealth Corporate Office, 6 Serangoon North Ave 5, Singapore, 554910, Singapore.
authors.forename: Chern Hui Jeffrey
authors.initials: CHJ
authors.lastname: Fong
authors.affiliation: CEO's Office, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Han Seong
authors.initials: HS
authors.lastname: Ng
authors.affiliation: Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.|Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Kok Yong
authors.initials: KY
authors.lastname: Fong
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*
keywords: ICD-9-AM; Risk factor; SLE; TB