Infection in Southern Chinese Patients with Systemic Lupus Erythematosus: Spectrum, Drug Resistance, Outcomes, and Risk Factors

2016 ◽  
Vol 43 (9) ◽  
pp. 1650-1656 ◽  
Author(s):  
Dongying Chen ◽  
Jingyi Xie ◽  
Haihong Chen ◽  
Ying Yang ◽  
Zhongping Zhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Viral Infection ◽  
Fungal Infection ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Hospitalized Patients ◽  
Chinese Patients ◽  
Systemic Lupus ◽  
Accumulated Dose

Objective.To investigate the spectrum, antibiotic-resistant pattern, risk factors, and outcomes of infection in patients hospitalized with systemic lupus erythematosus (SLE).Methods.We collected the clinical and microbiological data from hospitalized patients with SLE with infection between June 2005 and June 2015, and then conducted retrospective analyses.Results.Among our sample of 3815 hospitalized patients, 1321 (34.6%) were diagnosed with infection. The majority (78.3%) of infection occurred within 5 years of SLE onset. Bacterial infection was predominant (50.6%), followed by viral infection (36.4%) and fungal infection (12.5%). The lungs (33.7%) and upper respiratory tracts (26.3%) were most commonly affected. Gram-negative bacteria (GNB) were predominant over gram-positive bacteria (178 isolates vs 90 isolates). The most frequently isolated bacteria were Escherichia coli (24.6%), followed by Acinetobacter baumannii (13.4%) and coagulase-negative Staphylococcus (13.4%). Multidrug-resistant (MDR) strains were detected in 26.9% of bacterial isolates. The most common fungus was Candida spp. (99 episodes), followed by Aspergillus (24 episodes) and Cryptococcus neoformans (13 episodes). The overall mortality rate for this cohort was 2.2%; 48 patients died of infection. Factors associated with bacterial and viral infection were higher Systemic Lupus Erythematosus Disease Activity Index, renal involvement, thrombocytopenia, accumulated dose of glucocorticoids (GC), and treatment with cyclophosphamide (CYC). Renal involvement, accumulated dose of GC, and treatment with CYC were associated with fungal infection.Conclusion.Infection was the leading cause of mortality in patients hospitalized with SLE. There were some notable features of infection in Chinese patients including early onset, higher proportion of respiratory tract involvement, predominance of GNB with emergence of MDR isolates, and a variety of pathogens.

scholarly journals FRI0549 RISK OF INVASIVE FUNGAL INFECTION IN SYSTEMIC LUPUS ERYTHEMATOSUS: A NATIONWIDE POPULATION-BASED STUDY IN TAIWAN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 876.1-876
Author(s):  
C. F. Su ◽  
C. C. Lai ◽  
T. H. LI ◽  
Y. F. Chang ◽  
Y. T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Mortality Rate ◽  
Fungal Infection ◽  
Incidence Rate ◽  
Invasive Fungal Infection ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Intravenous Steroid ◽  
Independent Risk Factors

Background:Infectious disease is one of the leading causes of mortality in systemic lupus erythematosus (SLE). Among these infections, invasive fungal infection (IFI) carries high mortality rate (25-70%), but the literature of IFI in SLE is limited.Objectives:To investigate the epidemiology and risk factors of invasive fungal infection and its subtypes, including candidiasis, aspergillosis, and cryptococcosis, in SLE patients.Methods:All patients with newly diagnosed SLE between 1997-2012 were enrolled from Taiwan National Health Insurance Research Database, with an age- and sex-matched non-SLE control group in a ratio of 1:10. IFI was identified by ICD9 codes1from discharge record and validated by use of systemic anti-fungal agents. The incidence rate (IR), incidence rate ratio (IRR), cause mortality rate of IFI and its subtypes were compared. A Cox multivariate model with time-dependent covariates was applied to analyse the independent risk factors of IFI.Results:A total of 269 951 subjects (24 541 SLE and 245 410 control) were included. There were 445 episodes of IFI in SLE group. Candida was the most common pathogen (52.8%), followed by cryptococcus and aspergillus. The IR of IFI in SLE was 20.83 per 10,000 person-years with an IRR of 11.1 (95% CI 9.8-12.6) compared to the control (figure 1). Kaplan-Meier curve also disclosed a lower IFI-free survival in SLE (figure 2). The all-cause mortality rate was similar between SLE and the control (26.7 vs 25.7%). In SLE, treatment with mycophenolate mofetil (HR=2.24, 95% CI 1.48-3.37), cyclosporin (HR=1.65, 95% CI 1.10-1.75), cyclophosphamide (HR=1.37, 95% CI 1.07-1.75), oral daily dose of steroid>5 mg prednisolone (HR=1.26, 95% CI 1.01-1.58), and intravenous steroid therapy (HR=29.11, 95% CI 23.30-36.37) were identified as independent risk factors of IFI. Similar analyses were performed for subtypes of IFI. Distinctive risk factors were found between different subtypes of IFI (table 1).Conclusion:SLE patients have a higher risk of IFI. Intravenous steroid therapy is the most important risk factor of IFI. This study provides crucial information for risk stratification of IFI in SLE.References:[1] Winthrop KL, Novosad SA, Baddley JW, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. 2015 Dec; 74(12):2107-2116.Disclosure of Interests:None declared

scholarly journals Connective tissue disease-associated pulmonary arterial hypertension in Chinese patients

2014 ◽  
Vol 44 (4) ◽  
pp. 963-972 ◽  
Author(s):  
Yan-Jie Hao ◽  
Xin Jiang ◽  
Wei Zhou ◽  
Yong Wang ◽  
Lan Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Pulmonary Arterial Hypertension ◽  
Connective Tissue ◽  
Arterial Hypertension ◽  
Connective Tissue Disease ◽  
Lupus Erythematosus ◽  
Chinese Patients ◽  
Systemic Lupus ◽  
Pulmonary Arterial

We sought to investigate the characteristics, survival and risk factors for mortality in Chinese patients with connective tissue disease (CTD)-associated pulmonary arterial hypertension (APAH) in modern therapy era.129 consecutive adult patients who visited one of three referral centres in China with a diagnosis of CTD-APAH confirmed by right heart catheterisation during the previous 5 years were enrolled. The end-point was all-cause death or data censoring.Systemic lupus erythematosus was the most common underlying CTD (49%) and systemic sclerosis just accounted for 6% in this cohort. The overall survival at 1 and 3 years was 92% and 80%, respectively. Pericardial effusion, a shorter 6-min walk distance, lower mixed venous oxygen saturation, higher pulmonary vascular resistance (PVR) and alkaline phosphatase (ALP), and lower total cholesterol levels were all associated with a higher risk of death among the study population. Higher PVR and ALP were independent predictors of mortality.In conclusion, unlike in western patients, systemic lupus erythematosus is the most common underlying disease in Chinese patients with CTD-APAH. The survival of Chinese patients with CTD-APAH in the modern treatment era is similar to that in western countries. Elevated PVR and ALP are independent risk factors for poor outcomes.

scholarly journals 2655. A Prospective Study of Cytomegalovirus Infection in Active Systemic Lupus Erythematosus Patients with Intense Immunosuppressive Therapy: Epidemiology, Associated Risk Factors, Pathogenesis, and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S929-S929
Author(s):  
Asalaysa Bushyakanist ◽  
Porpon Rotjanapan ◽  
Pintip Ngamjanyaporn ◽  
Tanitta Suangtamai ◽  
Jackrapong Bruminhent ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Immunosuppressive Therapy ◽  
Clinical Outcomes ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Renal Involvement ◽  
Cmv Infection ◽  
Systemic Lupus ◽  
Associated Risk Factors

Abstract Background Systemic lupus erythematosus (SLE) patients with intense immunosuppressive therapy (IT) are at higher risk for cytomegalovirus (CMV) reactivation and may develop the end-organ disease. However, the real epidemiology, associated risk factors, pathogenesis, and clinical outcomes have not been fully elucidated. Objectives To investigate the associated risk factors, possible predictors in the aspect of immunology of CMV infection and to study epidemiology, and clinical outcomes prospectively in active SLE patients within 3 months after intense IT. Methods A prospective cohort study of active SLE patients required intense IT from November 2017 to March 2019 was conducted. We collected patients’ demographics, potential risk factors, onset and presentations of CMV infection after intense IT, data on IT, cytokine panels, and flow cytometry at weeks 0, 2, 4, 8, and 12 after enrollment. Intense IT was defined as an induction therapy of active SLE disease with either the National Institute of Health or Euro-Lupus Nephritis Trial protocol regimens. Results A total of 24 patients have enrolled with a median age of 32 years old and 22/24 patients were female. Renal involvement was the most common and found in 79.2% of the patients. Median SLE disease activity index at enrollment was 14 (25%-75% interquartile range (IQR) = 8–19). At week 0, no CMV infection was documented, 91.7% of the patients had positive CMV IgG, and the median absolute lymphocyte count was 938 cells/mm3. At week 12, the median cumulative corticosteroid dose was 0.74 mg/kg/day (25%-75%IQR = 0.34–1.20) and the prevalence of CMV infection was 12.5%. Elevated interleukin-23 and tumor necrotic factor-α levels were associated with protective effect (hazard ratio (HR) 0.12, 95% confidence interval (CI) 0.02–0.58, p = 0.009 and HR 0.55, 95% CI 0.31–0.99, p = 0.049, respectively). Neurologic involvement was the independent factor that increased the risk of CMV infection (HR 0.26; 95% CI 0.08–0.79, p = 0.018). No mortality was detected. Conclusion CMV infection is common when IT is used, but only some SLE patients with intense IT develop CMV infection. Certain characteristics of the patients may assist predict future CMV infection following IT. However, further study on a larger scale is encouraged. Disclosures All authors: No reported disclosures.

Invasive fungal infection in Chinese patients with systemic lupus erythematosus

2012 ◽  
Vol 31 (7) ◽  
pp. 1087-1091 ◽  
Author(s):  
Guang-liang Chen ◽  
Yi Chen ◽  
Chang-qing Zhu ◽  
Cheng-de Yang ◽  
Shuang Ye
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Lupus Erythematosus ◽  
Chinese Patients ◽  
Systemic Lupus

Predictors of Incident Seizure in Systemic Lupus Erythematosus

2016 ◽  
Vol 43 (3) ◽  
pp. 565-575 ◽  
Author(s):  
XiangYang Huang ◽  
Laurence S. Magder ◽  
Michelle Petri
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Multivariable Analysis ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Malar Rash ◽  
History Of

Objective.The risk factors for incident seizures in systemic lupus erythematosus (SLE) were prospectively determined in a cohort study.Methods.A total of 2203 patients with SLE followed longitudinally in the Hopkins Lupus Cohort were analyzed. Demographic variables, clinical manifestations, laboratory tests, and SLE disease activity were recorded at each quarterly visit. Adjusted estimates of association of risk factors for onset of seizure were derived using pooled logistic regression. We examined incident seizures in 3 ways: at the time of diagnosis, more than 45 days after the diagnosis of SLE, and after cohort entry.Results.Of 2203 patients with no history of seizure prior to SLE diagnosis, 157 (7.13%) had the first seizure occurrence at the time of (37 patients, 1.68%) or after diagnosis (120 patients, 5.45%) of SLE. The risk of seizure occurring around the time of SLE diagnosis was higher in patients with a history of malar rash (p = 0.002), proteinuria (p = 0.004), and psychosis (p < 0.001). Multivariable analysis of the first seizure occurring after the diagnosis of SLE showed that history of low C3 (p = 0.0078), psychosis (p < 0.0001), cranial or peripheral neuropathy (p = 0.0043), anti-Sm antibody (p = 0.0551), renal involvement (p = 0.0177), and current corticosteroid dose (p < 0.0001) were independently associated with a higher incidence of seizure. Disease activity was not predictive after adjusting for corticosteroids.Conclusion.Risk of seizure after diagnosis of SLE is increased in those patients with prior psychosis, neuropathy, proteinuria, anti-Sm, low C3, and use of corticosteroids.

Prevalence and treatment conditions for hypertension and dyslipidaemia complicated with systemic lupus erythematosus: A multi-centre cross-sectional study

Lupus ◽  
2021 ◽  
pp. 096120332110067
Author(s):  
Mayu Saito ◽  
Nobuyuki Yajima ◽  
Ryo Yanai ◽  
Yumi Tsubokura ◽  
Kunihiro Ichinose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Blood Pressure ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Treatment Conditions

Objective This study aimed to assess the prevalence and actual treatment conditions for hypertension and dyslipidaemia complicated with systemic lupus erythematosus (SLE). Methods This was a cross-sectional study. We established the lupus registry of nationwide institutions (LUNA), a multi-centre cohort of SLE patients in Japan. From February 2016 to July 2018, 597 SLE patients were registered in the LUNA. We evaluated the incidence of hypertension and dyslipidaemia and analysed the risk factors for hypertension and dyslipidaemia by logistic regression analysis. Results Overall, 597 patients were enrolled in the study. The median age was 44 years, and 88.0% of the patients were female. Among all the patients, 92.9% used prednisolone. The prevalence of hypertension and dyslipidaemia was 43.9% and 54.7%, respectively. Among the patients receiving medication for hypertension, 24.7% exhibited insufficient control (systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg), and among those receiving medication for hyperlipidaemia, 48.1% showed insufficient control (low-density lipoprotein cholesterol >140 mg/dL or triglyceride >150 mg/dL). The risk factors for hypertension were age, body mass index (BMI), disease duration, past maximum dose of prednisolone, and renal involvement, whereas those for dyslipidaemia were age and BMI. Conclusion About half of the patients had hypertension or dyslipidaemia, and a considerable number of cases were poorly controlled despite medication. Our data suggest that physicians should treat SLE activity as well as its complications, especially the common risk factors for atherosclerosis.

scholarly journals Thrombocytopenia Is an Independent Risk Factor for the Prognosis of Thrombotic Microangiopathy in Chinese Patients With Systemic Lupus Erythematosus

2021 ◽  
Vol 8 ◽  
Author(s):  
Fan Yang ◽  
Junwei Tian ◽  
Linyi Peng ◽  
Li Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Platelet Count ◽  
Lupus Erythematosus ◽  
Thrombotic Microangiopathy ◽  
Independent Risk Factor ◽  
Chinese Patients ◽  
Systemic Lupus

Objectives: This study aims to describe clinical characteristics and outcome of thrombotic microangiopathy (TMA) in Chinese patients with systemic lupus erythematosus (SLE), and investigate the risk factors.Methods: We conducted a retrospective single-center cohort and enrolled patients of TMA associated with SLE between January 2015 and December 2018. Demographic characteristics, clinical features, laboratory profiles, therapeutic strategies, and outcomes were collected. The risk factors of TMA in patients with SLE for mortality using multivariate analysis were estimated.Results: A total of 119 patients with a diagnosis of TMA were enrolled within the study period in our center, and SLE was found in 72 (60.5%) patients. The mean age was 29.2 ± 10.1 and 65 (92.3%) were women. Only 15 patients were found with definite causes, the other 57 cases remained with unclear reasons. Sixty-two patients got improved, while 10 patients died after treatment (mortality rate: 13.9%). Compared with the survival group, the deceased group had a higher prevalence of neuropsychiatric manifestations, infection with two or more sites, increased levels of C-reaction protein (CRP) and D-Dimer, and decreased platelet count. Multivariate analysis showed that the decrease of platelet count is the independent risk factor for in-hospital mortality for TMA in patients with SLE. The receiver operating characteristic (ROC) curve analysis displayed that a cutoff value of &lt;18 × 109/L for platelet count could significantly increase the risk of death.Conclusions: Thrombotic microangiopathy often occurs in patients with active SLE with high mortality (13.9%), and thrombocytopenia, especially when the platelet count is lower than 18 × 109/L, is the risk factor for death.

Sign in / Sign up

Export Citation Format

Share Document