Active systemic lupus erythematosus patients more susceptible to infections: BMJ

China: Patients with freshly onset active systemic lupus erythematosus (SLE) are more susceptible to serious infections, because of the underlying immunological disorder, says an article published in BMJ Lupus Science and Medicine.

SLE is a multi-systemic chronic autoimmune disease that has high morbidity and mortality. It has been well established that fatalities follow a bimodal pattern, with early deaths (1 year) often caused by active SLE or infection and late deaths mostly caused by atherosclerotic vascular disease. In this study, Haiting Wang and colleagues sought to describe severe infection episodes within the first year of follow-up and build a risk assessment tool for infection prediction using an observational inception cohort of Chinese patients with recently diagnosed SLE (3 months) from their center.

Between 1 January 2013 and 1 November 2020, a newly diagnosed (within 3 months) hospitalized Systemic Lupus Inception Cohort (hSLIC) was created. Every patient was monitored for at least a year or until they passed away. We gathered the patient's baseline characteristics. Major infection events—defined as microbiological/clinical-based diagnoses treated with intravenous antibiotics—were noted throughout follow-up. An additional training set and a testing set were created from the cohort. 

The key highlights of this study were:

1. During the first year of follow-up, 69 recorded occurrences of severe infections occurred in 67 (14%) of the 494 patients who were included in the hSLIC group.

2. Major infection episodes were more likely to occur within the first four months of enrollment (94%, 65/69) and were linked to all-cause death.

3. A prediction model based on the SLE Disease Activity Index >10, peripheral lymphocyte count 0.8 109/L, and serum creatinine >104 mol/L was developed after glucocorticoid and immunosuppressant exposure adjustments to identify patients at low risk (3%–5%) or high risk (37%–39%) of major infections within the first four months.

In conclusion, using the right prediction tool to identify high-risk Systemic lupus erythematosus patients may result in better care and also decrease the adverse outcome.

Reference: 

Wang, H., Zhou, Y., Yu, L., Wu, W., Zhao, L., Geng, S., Sun, F., Zhang, D., Shen, N., Chen, Y., & Ye, S. (2022). Major infections in newly diagnosed systemic lupus erythematosus: an inception cohort study. Lupus Science & Medicine, 9(1), e000725. https://doi.org/10.1136/lupus-2022-000725