TY - JOUR
T1 - Predictors of infection requiring hospitalization in patients with systemic lupus erythematosus
T2 - a time-to-event analysis
AU - Ko, Tina
AU - Koelmeyer, Rachel
AU - Li, Ning
AU - Yap, Kristy
AU - Yeo, Ai Li
AU - Kent, Joanna
AU - Pellicano, Rebecca
AU - Golder, Vera
AU - Kitching, A. Richard
AU - Morand, Eric
AU - Hoi, Alberta
N1 - Funding Information:
We thank the SLE patients who kindly consented to the use of their data and samples for research purposes. We also thank the clinical staff of the Monash Lupus Clinic for their assistance with data collection for the ALRB. Declaration of interest: AH reports grants from Astra Zeneca and Merk KGaA outside the submitted work; sponsorship of the Australian Lupus Registry and Biobank which is chaired by AH is received from Janssen, BMS, Astra Zeneca, and UCB. AH also reports meeting support from Janssen and consulting fees from Abbvie, Janssen and GSK. AH is honorary treasurer and board member for the Australian Rheumatology Association. EM reports grants from Abbvie, Amgen, Astra Zeneca, Biogen, BristolMyersSquibb, Eli Lilly, EMD Serano, Genentech, Glaxosmithkline, Janssen and UCB, as well as consulting fees from AstraZeneca, Biogen, BristolMyersSquibb, Eli Lily, EMD Serano, Novartis, Servier and Zenas all of which were outside the submitted work. EM also reports payment or honoraria for educational events from AstraZeneca, Gilead and ONO, meeting support from AstraZeneca, patents with Monash University and AstraZeneca and director role for Rare Voices Australia.
Publisher Copyright:
© 2022
PY - 2022/12
Y1 - 2022/12
N2 - Objectives: To evaluate the predictors of serious infection in patients with systemic lupus erythematosus (SLE). Methods: Serious infections were identified in SLE patients in a prospectively-followed single centre cohort. Associations of serious infection with disease-related variables and medication use were analysed using Cox and related regression models. Results: 346 patients were followed for a mean (SD) of 6.6 (3.7) years. 86 episodes of serious infection were observed, with an incidence rate of 3.8 episodes per 100 person-years. Patients who had serious infection had higher baseline SLE Damage Index (SDI) and Charlston Comorbidity Index (CCI); they were also more likely to have high disease activity status (HDAS), and higher disease activity in multiple clinical domains, higher flare rates, higher time-adjusted prednisolone dose exposure, and less time in lupus low disease activity state (LLDAS). Patients who have received cyclophosphamide, rituximab and mycophenolate were more likely to have experienced serious infection. After multivariable adjustment in Cox regression analysis, cyclophosphamide, higher SDI score, and higher disease activity were associated with an increased hazard of first serious infection. History of previous serious infection conferred the highest risk. Lymphopenia was also a modest but statistically significant predictor of serious infection. Conclusion: History of previous serious infection was the strongest predictor of serious infection in our SLE cohort. This study also suggests that clinical factors such as damage accrual, disease activity, and choice of immunosuppressant, can each have an independent risk in predicting serious infection particularly the first episode.
AB - Objectives: To evaluate the predictors of serious infection in patients with systemic lupus erythematosus (SLE). Methods: Serious infections were identified in SLE patients in a prospectively-followed single centre cohort. Associations of serious infection with disease-related variables and medication use were analysed using Cox and related regression models. Results: 346 patients were followed for a mean (SD) of 6.6 (3.7) years. 86 episodes of serious infection were observed, with an incidence rate of 3.8 episodes per 100 person-years. Patients who had serious infection had higher baseline SLE Damage Index (SDI) and Charlston Comorbidity Index (CCI); they were also more likely to have high disease activity status (HDAS), and higher disease activity in multiple clinical domains, higher flare rates, higher time-adjusted prednisolone dose exposure, and less time in lupus low disease activity state (LLDAS). Patients who have received cyclophosphamide, rituximab and mycophenolate were more likely to have experienced serious infection. After multivariable adjustment in Cox regression analysis, cyclophosphamide, higher SDI score, and higher disease activity were associated with an increased hazard of first serious infection. History of previous serious infection conferred the highest risk. Lymphopenia was also a modest but statistically significant predictor of serious infection. Conclusion: History of previous serious infection was the strongest predictor of serious infection in our SLE cohort. This study also suggests that clinical factors such as damage accrual, disease activity, and choice of immunosuppressant, can each have an independent risk in predicting serious infection particularly the first episode.
KW - High Disease Activity Status (HDAS)
KW - Infection
KW - Lupus Low Disease Activity State (LLDAS)
KW - Systemic Lupus Erythematosus (SLE)
UR - http://www.scopus.com/inward/record.url?scp=85138499003&partnerID=8YFLogxK
U2 - 10.1016/j.semarthrit.2022.152099
DO - 10.1016/j.semarthrit.2022.152099
M3 - Article
AN - SCOPUS:85138499003
SN - 0049-0172
VL - 57
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
M1 - 152099
ER -