González-Echavarri C, Capdevila O, Espinosa G, Suárez S, Marín-Ballvé A, González-León R, Rodríguez-Carballeira M, Fonseca-Aizpuru E, Pinilla B, Pallarés L, Ruiz-Irastorza G
1 Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
2 Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain.
Lupus. 2018 Dec;27(14):2253-2261. doi: 10.1177/0961203318811598.
Using data of patients from the inception cohort Registro Español de Lupus Eritematoso Sistémico (RELES), we aimed to analyse the incidence of severe infection in the first two years of follow-up and how predictors of infection change during the course of systemic lupus erythematosus (SLE).
The study included 282 patients. Markers of lupus activity, prednisone doses and immunosuppressive therapy were compared between patients with and without infections in the first and second year of the disease. Drug therapy administered during the first month of follow-up has been considered as a potential predictor of infections during the first year and medications administered during the first year have been considered potential predictors of infections during the second.
Nineteen patients (6.4%) had a documented episode of major infection during the first year of follow-up and 16 patients (5.67%) during the second. The following variables were associated with infections during the first year: hypocomplementaemia at diagnosis ( p < 0.01), nephritis at diagnosis ( p = 0.03), SLEDAI score ( p < 0.01), prednisone >30 mg/day ( p = 0.01), methylprednisolone pulses ( p = 0.05) and mycophenolate use ( p = 0.02). The independent variables in the final model were hypocomplementaemia (odds ratio (OR) 4.41, 95% confidence interval (CI) 0.96-20.20, p = 0.05) and a dose of prednisone >30 mg/day (OR 6.60, 95% CI 1.34-32.42, p = 0.02). The following variables were associated with infections during the second year: dose of prednisone > 7.5 mg/day ( p = 0.05), methylprednisolone pulses ( p = 0.07), duration of therapy with antimalarials ( p = 0.09), therapy with mycophenolate ( p = 0.01), therapy with cyclophosphamide ( p = 0.05). The independent variables in the final model were a dose of prednisone >7.5 mg/day (OR 4.52, 95% CI 0.99-21, p = 0.054) and duration of therapy with antimalarials as a protective factor (OR 0.99, 95% CI 0.99-1.00, p = 0.053).
The low incidence of early infections in the RELES cohort is partially explained by the extended use of antimalarials and by the general avoidance of prolonged high doses of prednisone. Patients with high baseline activity are at a higher risk of infection during the first months but therapy with medium-high doses of prednisone is the main predictor of infectious events. Thus, every effort should be made to limit oral glucocorticoid use from the very beginning of the SLE course.
利用初始队列西班牙系统性红斑狼疮注册研究（RELES）中患者的数据，我们旨在分析随访前两年严重感染的发生率以及系统性红斑狼疮（SLE）病程中感染的预测因素如何变化。
该研究纳入了282例患者。对疾病第一年和第二年有感染与无感染患者的狼疮活动指标、泼尼松剂量和免疫抑制治疗进行了比较。随访第一个月给予的药物治疗被视为第一年感染的潜在预测因素，第一年给予的药物被视为第二年感染的潜在预测因素。
19例患者（6.4%）在随访第一年有记录的严重感染发作，16例患者（5.67%）在第二年有记录的严重感染发作。以下变量与第一年的感染相关：诊断时低补体血症（p < 0.01）、诊断时肾炎（p = 0.03）、SLE疾病活动指数（SLEDAI）评分（p < 0.01）、泼尼松>30 mg/天（p = 0.01）、甲泼尼龙冲击治疗（p = 0.05）和霉酚酸酯的使用（p = 0.02）。最终模型中的独立变量为低补体血症（比值比（OR）4.41，95%置信区间（CI）0.96 - 20.20，p = 0.05）和泼尼松剂量>30 mg/天（OR 6.60，95% CI 1.34 - 32.42，p = 0.02）。以下变量与第二年的感染相关：泼尼松剂量>7.5 mg/天（p = 0.05）、甲泼尼龙冲击治疗（p = 0.07）、抗疟药治疗持续时间（p = 0.09）、霉酚酸酯治疗（p = 0.01）、环磷酰胺治疗（p = 0.05）。最终模型中的独立变量为泼尼松剂量>7.5 mg/天（OR 4.52，95% CI 0.99 - 21，p = 0.054）和抗疟药治疗持续时间作为保护因素（OR 0.99，95% CI 0.99 - 1.00，p = 0.053）。
RELES队列中早期感染发生率低部分归因于抗疟药的广泛使用以及普遍避免长期高剂量使用泼尼松。基线活动度高的患者在最初几个月感染风险较高，但中高剂量泼尼松治疗是感染事件的主要预测因素。因此，应从SLE病程一开始就尽一切努力限制口服糖皮质激素的使用。
