多中心回顾性队列研究评估狼疮肾炎患者与非肾脏系统性红斑狼疮患者严重感染的发生率。

Multicentre retrospective cohort study assessing the incidence of serious infections in patients with lupus nephritis, compared with non-renal systemic lupus erythematosus.

机构信息

Rheumatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia

Renal Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

出版信息

Lupus Sci Med. 2020 Sep;7(1). doi: 10.1136/lupus-2020-000390.

DOI:10.1136/lupus-2020-000390

PMID:32963113

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7509980/

Abstract

OBJECTIVES

The incidence of serious infections is poorly defined in patients with lupus nephritis (LN). It is also unclear if LN influences risk of serious infections in a longitudinal analysis. The aim of this study was to determine the incidence of serious infections in patients with SLE and LN, compared with patients with SLE without LN.

METHODS

A multicentre retrospective cohort study was conducted. Patients with LN identified at two tertiary centres were matched where possible with age and gender-matched patients with SLE without LN.Any infection requiring inpatient admission, occurring in the 6 months following index clinical visit, was considered serious. Cox regression was employed to investigate the association between risk of serious infection and LN status, and other relevant covariates.

RESULTS

A total of 173 patients were included within the analysis (n=87 LN, n=86 SLE only). A total of 9.2% (n=8) of patients with LN experienced at least one serious infection within the study period, compared with 5.8% (n=5) of patients without LN, equivalent to 19.5 and 12.0 infections per 100 patient-years with and without LN, respectively. Univariable and multivariable analyses found no significant increased risk of serious infection in patients with LN versus controls (HR 1.61; 95% CI 0.53 to 4.92 and adjusted HR (aHR) 0.91; 95% CI 0.27 to 3.06, respectively). Increased prednisone dose and modified SLE comorbidity index were strongly associated with serious infection (aHR (per 5 mg) 1.21; 95% CI 1.07 to 1.37; p=0.003 and aHR 1.13; 95% CI 1.02 to 1.25; p=0.018, respectively).

CONCLUSIONS

In this cohort, adjusting for cofactors, the presence of LN alone does not appear to increase the risk of serious infections compared with patients with SLE without LN. However, increased prednisone dose at baseline visit and increasing comorbidity were independently associated with the incidence of serious infection.

摘要

目的

狼疮肾炎（LN）患者严重感染的发生率定义较差。LN 是否会影响纵向分析中的严重感染风险也不清楚。本研究的目的是确定 LN 与无 LN 的 SLE 患者相比，SLE 合并 LN 患者严重感染的发生率。

方法

进行了一项多中心回顾性队列研究。在两个三级中心确定的 LN 患者尽可能与年龄和性别匹配的无 LN 的 SLE 患者相匹配。索引临床就诊后 6 个月内发生的任何需要住院治疗的感染均被视为严重感染。采用 Cox 回归分析 LN 状态与严重感染风险之间的关系，以及其他相关协变量。

结果

共有 173 名患者纳入分析（LN 患者 87 例，仅 SLE 患者 86 例）。研究期间，LN 组有 9.2%（8 例）的患者至少发生一次严重感染，而无 LN 组有 5.8%（5 例）的患者发生严重感染，LN 组和无 LN 组的感染发生率分别为每 100 患者年 19.5 和 12.0 例。单变量和多变量分析发现，LN 患者与对照组相比，严重感染的风险无显著增加（HR 1.61；95%CI 0.53 至 4.92 和调整后的 HR（aHR）0.91；95%CI 0.27 至 3.06）。泼尼松剂量增加和改良的 SLE 合并症指数与严重感染强烈相关（每增加 5mg 泼尼松的 aHR 为 1.21；95%CI 1.07 至 1.37；p=0.003 和 aHR 为 1.13；95%CI 1.02 至 1.25；p=0.018）。