Background Despite the improvement of survival rates in SLE patients over the past decades, patients still have higher mortalities compared with the general population that can be largely attributed to uncontrolled disease activities and, most importantly, various kinds of severe infections.
Objectives The aim of this study is to identify the clinical differences between central nervous system (CNS) infection and neuropsychiatric lupus (NPSLE) in patients with systemic lupus erythematosus (SLE).
Methods Clinical manifestations, laboratory test results and prognoses of 14 SLE patients complicated with various CNS infections, hospitalized in the Drum Tower Hospital in the past seven years, were reviewed and compared with those of 34 concomitantly treated NPSLE patients. The sensitivity and specificity for each variable to identify CNS infection was assessed by receiver operating characteristic (ROC) curves.
Results Our study shows that mortality rate was much higher in SLE patients with CNS infection than in NPSLE patients. Compared to NPSLE, those with CNS infection had lower lupus disease activity (SLEDAI), but took higher doses of corticosteroids one month before the occurrence of CNS symptoms. Headache, high fever and vomiting were more common in patients with CNS infections, accompanied with the elevation of C-reactive protein level. Cerebrospinal fluid examination (CSF) examination showed increased leukocytes and protein level but decreased glucose level in patients with CNS infections. Of all the variables, the combination of abnormal CSF test, low SLEDAI score, high fever and high intake of prednisone could best discriminate CNS infection from NPSLE in SLE patients (AUC=0.999, p=4.48x10–19).
Conclusions We conclude that for SLE patients who have CNS symptoms, low SLE disease activity but high intake of corticosteroids, together with abnormal CSF and high fever, may suggest the existence of CNS infection.
Disclosure of Interest : None declared