Department of Rheumatology. Hospital Comarcal de l'Alt Penedès-Garraf., Vilafranca del Penedès (Spain), C/ de l'Espirall, s/n, 08720, Vilafranca del Penedès, Spain.
Rheumatology Department, Parc de Salut Mar-IMIM, Barcelona, Spain.
Semin Arthritis Rheum. 2020 Aug;50(4):657-662. doi: 10.1016/j.semarthrit.2020.05.016. Epub 2020 May 30.
To assess the incidence of serious infection (SI) and associated factors in a large juvenile-onset systemic lupus erythematosus (jSLE) retrospective cohort.
All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria and disease onset <18 years old (jSLE), were retrospectively investigated for SI (defined as either the need for hospitalization with antibacterial therapy for a potentially fatal infection or death caused by the infection). Standardized SI rate was calculated per 100 patient years. Patients with and without SI were compared. Bivariate and multivariate logistic and Cox regression models were built to calculate associated factors to SI and relative risks.
A total of 353 jSLE patients were included: 88.7% female, 14.3 years (± 2.9) of age at diagnosis, 16.0 years (± 9.3) of disease duration and 31.5 years (±10.5) at end of follow-up. A total of 104 (29.5%) patients suffered 205 SI (1, 55.8%; 2-5, 38.4%; and ≥6, 5.8%). Incidence rate was 3.7 (95%CI: 3.2-4.2) SI per 100 patient years. Respiratory location and bacterial infections were the most frequent. Higher number of SLE classification criteria, SLICC/ACR DI score and immunosuppressants use were associated to the presence of SI. Associated factors to shorter time to first infection were higher number of SLE criteria, splenectomy and immunosuppressants use.
The risk of SI in jSLE patients is significant and higher than aSLE. It is associated to higher number of SLE criteria, damage accrual, some immunosuppressants and splenectomy.
评估大型青少年发病系统性红斑狼疮（jSLE）回顾性队列中严重感染（SI）的发生率及其相关因素。
对符合≥4 项 ACR-97 系统性红斑狼疮（SLE）标准且发病年龄<18 岁（jSLE）的西班牙风湿病学会狼疮登记处（RELESSER）所有患者进行回顾性调查，以确定 SI（定义为需要住院接受抗菌治疗以治疗潜在致命感染或感染导致的死亡）。按每 100 患者年计算标准化 SI 率。比较有和无 SI 的患者。建立了二变量和多变量逻辑和 Cox 回归模型，以计算与 SI 相关的因素和相对风险。
共纳入 353 例 jSLE 患者：88.7%为女性，诊断时年龄为 14.3 岁（±2.9），疾病持续时间为 16.0 岁（±9.3），随访结束时年龄为 31.5 岁（±10.5）。共有 104 例（29.5%）患者发生 205 次 SI（1 次，55.8%；2-5 次，38.4%；≥6 次，5.8%）。SI 发生率为每 100 患者年 3.7（95%CI：3.2-4.2）。呼吸道部位和细菌感染最常见。SLE 分类标准、SLICC/ACR DI 评分和免疫抑制剂使用的数量与 SI 的存在相关。与首次感染时间较短相关的因素包括 SLE 标准数量、脾切除术和免疫抑制剂使用。
jSLE 患者发生 SI 的风险显著高于 aSLE，与 SLE 标准数量增加、器官损害、某些免疫抑制剂和脾切除术相关。
