欠发达地区新诊断为系统性红斑狼疮的住院患儿的感染情况。

Infections in hospitalized children with newly diagnosed systemic lupus erythematosus in underresourced areas.

机构信息

Division of Nephrology, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

出版信息

Lupus. 2020 Oct;29(11):1475-1482. doi: 10.1177/0961203320939164. Epub 2020 Jul 7.

DOI:10.1177/0961203320939164

PMID:32635882

Abstract

BACKGROUND

The administration of induction immunosuppressive therapy to children with newly diagnosed systemic lupus erythematosus (SLE) and concurrent infections can lead to unfavourable outcomes. This study was conducted to describe characteristics of infections occurring before the initiation of immunosuppressants in hospitalized children with newly diagnosed SLE in underresourced areas.

METHODS

Medical records of paediatric patients with the diagnosis of SLE, who were admitted to a university-based hospital from 2002 to 2018, were reviewed. Only patients younger than 18 years of age with newly diagnosed SLE were included in the study. The primary outcome was infection before the administration of immunosuppressants. Logistic regression analysis was used to determine factors associated with infection and adjusted odds ratio (OR). The diagnostic accuracy of CRP was assessed.

RESULTS

Infections were confirmed in 52/124 (41.9%) children. Pathogens were identified in 24 (46.2%) patients with bacterial predominance. The most common site was respiratory infections (36.5%). Fever and serosal involvement were more prevalent in patients with infection. Serum CRP levels were significantly higher in patients with infection than in those without infection (median 5.5 mg/L (interquartile range (IQR) 3.6-76.3 mg/L) vs. 3.5 mg/L (IQR 3.0-3.6 mg/L), = 0.004). When a positive CRP level of >5 mg/L was used, positive CRP was found with a higher prevalence in patients with infection and was independently associated with infection (adjusted odds ratio (OR) = 28.6, 95% confidence interval (CI) 2.3-350.6; = 0.009). Patients with infection had a longer hospital stay than patients without infection (median 20 days (IQR 13-25 days) vs. 15 days (IQR 9-24 days), = 0.04). Sensitivity, specificity, positive predictive value and negative predictive value with 95% CI of CRP >5 mg/L were 62.5% (35.4-84.8%), 88.9% (65.3-98.6%), 80.3% (51.0-94.1%) and 76.6% (63.1-86.3%), respectively.

CONCLUSIONS

Infections were common among hospitalized children with newly diagnosed SLE. Children with infections had a prolonged course of hospitalization. Positive CRP was associated with a predisposition towards infection. However, the diagnostic accuracy of CRP requires further validation in a larger study.

摘要

背景

在资源匮乏地区，给患有新诊断系统性红斑狼疮（SLE）且合并感染的儿童应用诱导免疫抑制治疗会导致不良结局。本研究旨在描述在接受免疫抑制剂治疗前，新诊断的 SLE 住院患儿发生感染的特征。

方法

对 2002 年至 2018 年期间在一所大学附属医院住院的小儿 SLE 患者的病历进行了回顾性分析。仅纳入年龄小于 18 岁且新诊断为 SLE 的患者。主要结局是免疫抑制剂治疗前的感染。采用 logistic 回归分析确定与感染相关的因素，并调整比值比（OR）。评估了 CRP 的诊断准确性。

结果

在 124 例患儿中，52 例（41.9%）确诊为感染。24 例患儿（46.2%）培养出病原体，以细菌为主。最常见的感染部位为呼吸道（36.5%）。感染组发热和浆膜受累更为常见。与无感染组相比，感染组患儿血清 CRP 水平显著升高（中位数 5.5mg/L（IQR 3.6-76.3mg/L）比 3.5mg/L（IQR 3.0-3.6mg/L）， = 0.004）。当 CRP 阳性界值设定为>5mg/L 时，感染组 CRP 阳性率更高，且与感染独立相关（调整 OR 值 28.6，95%可信区间 2.3-350.6； = 0.009）。感染组患儿的住院时间长于无感染组（中位数 20 天（IQR 13-25 天）比 15 天（IQR 9-24 天）， = 0.04）。CRP>5mg/L 的敏感性、特异性、阳性预测值和阴性预测值分别为 62.5%（35.4-84.8%）、88.9%（65.3-98.6%）、80.3%（51.0-94.1%）和 76.6%（63.1-86.3%）。