Yang Yanli, Jiang Hui, Wang Chuhan, Jiang Nan, Wu Chanyuan, Zhang Shangzhu, Jiang Wei, Peng Jinmin, Weng Li, Zhao Jiuliang, Wang Qian, Li Mengtao, Du Bin, Zhao Yan, Zeng Xiaofeng
Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Taiyuan, China.
Front Med (Lausanne). 2021 Sep 29;8:732681. doi: 10.3389/fmed.2021.732681. eCollection 2021.
To identify factors associated with mortality in SLE patients who were hospitalized for pulmonary infections (PIs). This single-center retrospective study analyzed the characteristics and risk factors for mortality in 95 SLE patients hospitalized for PIs. Ninety-five SLE patients had 97 episodes of hospitalization for PIs, and 33 of these episodes (34.02%) led to death. Death from PI was associated with a higher neutrophil count (6.30 vs. 4.201 × 10/L, < 0.01), immunoglobulin G (6.20 vs. 9.82 g/L, = 0.01), serum creatinine (126.00 vs. 73.00 μmol/L, = 0.01), proteinuria (2.99 vs. 0.54 g/day, < 0.01), cardiopulmonary involvement (57.58 vs. 34.38%, < 0.05), SLE disease activity index (SLEDAI; 11.00 vs. 6.00, < 0.05), and opportunistic infections (78.79 vs. 45.31%, < 0.05). Demographic characteristics, antibody/complements, bacterial infection, and primary treatment before infection (including corticosteroid and immunosuppressants) had no effect. Multivariate analysis indicated cardiopulmonary involvement (HR: 2.077; 95%CI: 1.022-4.220; = 0.043) and opportunistic infection (HR: 2.572; 95%CI: 1.104-5.993; = 0.029) were independent risk factors for mortality. High-dose steroid pulse therapy (HR: 0.982; 95%CI: 0.410-2.350; = 0.982) and first-line immunosuppressant therapy (HR: 1.635; 95%CI: 0.755-3.542, = 0.212) had no effect on mortality. Cardiopulmonary involvement and opportunistic infection were independent risk factors for mortality for SLE patients hospitalized for PIs. Use of high-dose pulse steroids and or immunosuppressants before hospitalization had no significant effects.
确定因肺部感染（PI）住院的系统性红斑狼疮（SLE）患者的死亡相关因素。这项单中心回顾性研究分析了95例因PI住院的SLE患者的特征及死亡风险因素。95例SLE患者发生了97次因PI的住院，其中33次（34.02%）导致死亡。PI相关死亡与较高的中性粒细胞计数（6.30 vs. 4.201×10⁹/L，P<0.01）、免疫球蛋白G（6.20 vs. 9.82 g/L，P = 0.01）、血清肌酐（126.00 vs. 73.00 μmol/L，P = 0.01）、蛋白尿（2.99 vs. 0.54 g/天，P<0.01）、心肺受累（57.58% vs. 34.38%，P<0.05）、SLE疾病活动指数（SLEDAI；11.00 vs. 6.00，P<0.05）及机会性感染（78.79% vs. 45.31%，P<0.05）相关。人口统计学特征、抗体/补体、细菌感染及感染前的初始治疗（包括皮质类固醇和免疫抑制剂）无影响。多因素分析表明心肺受累（HR：2.077；95%CI：1.022 - 4.220；P = 0.043）及机会性感染（HR：2.572；95%CI：1.104 - 5.993；P = 0.029）是死亡的独立危险因素。大剂量类固醇冲击治疗（HR：0.982；95%CI：0.410 - 2.350；P = 0.98）及一线免疫抑制剂治疗（HR：1.635；95%CI：0.755 - 3.542，P = 0.212）对死亡率无影响。心肺受累和机会性感染是因PI住院的SLE患者死亡的独立危险因素。住院前使用大剂量脉冲类固醇和/或免疫抑制剂无显著影响。
