Background Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by clinically heterogeneous manifestations. Infections can be the initial trigger to the development of autoimmunity. Initial presentation of SLE can mimic infections, and in turn infections can mimic disease flares in established SLE. Infections are an important cause of morbidity and mortality in SLE. Bacterial infections are most frequent, followed by viral and fungal infections. The impaired cellular and humoral immune functions seen in patients with SLE are predisposing conditions. Disease activity and high doses of methylprednisolone or cyclophosphamide are well-recognized risk factors for infection.
Objectives To determine the prevalence and mortality from infection in SLE patients as well as to identify etiology, associated factors to severity and site of infection.
Methods We performed a retrospective study from 2010 to 2014 in a referral hospital. We analyzed risk factors (RF) on admission, involved organ, infectious type and etiology. Statistical analysis: We did descriptive statistical, Chi2, multivariate analysis.
Results There were 328 patients, 87% women and 13% men, mean age 32.4±9.9 years. Infections as cause of hospitalizations were 42.2%, prevalence of infections was 49%, and mortality from severe infections was 45%. The RF for severe infections were: renal involvement Odds Ratio (OR) 3.057, P<0.019; hematologic OR 1.9, p<0.001; increased dsAnti-DNA RM 5.1 p<0001, hypocomplementaemia: OR 2.673, P<0.02, leukolymphopenia OR 2.5, p<0001. Type of infecctions: bacterial 87%, viral: 3.4%, fungal: 8%, mycobacterial: 1.5%. Site of infection: lower respiratory tract 38%, urinary tract: 49% soft tissues: 6.1%, central nervous system: 1.2%, Others: 4.2%. Most frequent etiology agent were: bacterial: S. aureus, E. coli, A. baumanii, E. faecalis. Virales: H. zoster, mycotic: candida albicans and M. tuberculosis.
Conclusions Infections are an important cause of morbidity, mortality and hospitalization in SLE patients. The lower respiratory tract infections of bacterial origen were most frequent. The renal and hematological involvement, increased dsAnti-DNA, hypocomplementaemia, and leukolymphopenia were the most important factors for severe infections. Infections in active SLE patients constitute a true challenge for the clinician
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Disclosure of Interest None declared