1 Department of Rheumatology, Hospital Nacional 'Guillermo Almenara Irigoyen' Essalud, Lima, Peru.
2 Universidad Científica del Sur, Lima, Peru.
Lupus. 2019 Aug;28(9):1101-1110. doi: 10.1177/0961203319860579. Epub 2019 Jul 10.
The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE).
A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed.
Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20-37) years and 47.8 (17.9-68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48-0.99; = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69-10.31; = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35-16.49; = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10-2.13; = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01-1.04; = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11-1.34; < 0.0001) were predictive factors of serious infections.
Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.
本研究旨在确定系统性红斑狼疮（SLE）患者随时间推移发生严重感染的预测因素。
研究了一个多民族、多国籍的拉丁美洲 SLE 队列。严重感染定义为需要住院治疗、住院期间发生或导致死亡的感染。潜在的预测因素包括社会人口因素、临床表现（按受累器官、淋巴细胞减少和白细胞减少分别）和基线时的既往感染。疾病活动度（SLEDAI）、损伤（SLICC/ACR 损伤指数）、非严重感染、糖皮质激素、抗疟药（使用者和非使用者）和免疫抑制剂的使用；后六个变量被视为时间依赖性协变量进行检查。使用向后消除程序的 Cox 回归模型评估严重感染的预测因素。进行单变量和多变量分析。
在纳入的 1243 名患者中，1116 名（89.8%）为女性。诊断和随访时间的中位数（四分位距）分别为 27 岁（20-37 岁）和 47.8 岁（17.9-68.6 个月）。严重感染的发生率为每 100 人年 3.8 例。抗疟药的使用（风险比：0.69；95%置信区间（CI）：0.48-0.99；=0.0440）具有保护作用，而泼尼松剂量>15 且≤60mg/天（风险比：4.18；95%CI：1.69-10.31；=0.0019）和>60mg/天（风险比：4.71；95%CI：1.35-16.49；=0.0153）、使用甲基强的松龙脉冲（风险比：1.53；95%CI：1.10-2.13；=0.0124）、疾病活动度增加（风险比：1.03；95%CI：1.01-1.04；=0.0016）和损伤累积（风险比：1.22；95%CI：1.11-1.34；<0.0001）是严重感染的预测因素。
随着时间的推移，泼尼松剂量高于 15mg/天、使用甲基强的松龙脉冲、疾病活动度增加和损伤累积是感染的预测因素，而抗疟药的使用可预防 SLE 患者发生感染。
