OP0043 INCREASED RISK OF SEVERE INFECTIONS AND MORTALITY IN PATIENTS WITH NEWLY DIAGNOSED SYSTEMIC LUPUS ERYTHEMATOSUS: A POPULATION-BASED STUDY
Authors: Zhao K. , Xie H. , LI L. , Aviña A. , Esdaile J. 
Published: May 2021

Background:

Systemic lupus erythematosus (SLE) is a chronic disease with a broad spectrum of autoantibodies and clinical manifestations. As much as 45% of SLE patients were reported to suffer from severe infections1,2. However, due to the high cost of recruiting patients, we still do not have a holistic picture of the SLE-infection association. Administrative data which encompass all provincially funded healthcare service data shows promising opportunities to advance the knowledge and management of the SLE patients which cannot be evaluated by the conventional clinical setting with small sample size and selective samples3,4,5.

Objectives:

To evaluate the risk of severe infection and infection-related mortality among patients with newly diagnosed systemic lupus erythematosus.

Methods:

We conducted an age- and gender- matched cohort study of all patients with incident SLE between January 1, 1997 and March 31, 2015 using administrative health data from British Columbia, Canada. Primary outcome was the first severe infection after SLE onset necessitating hospitalization or occurring during hospitalization. Secondary outcomes were total number of severe infections and infection-related mortality.

Results:

We identified 5,169 SLE patients and matched them with 25,845 non-SLE individuals from the general population, yielding 955 and 1,986 first severe infections during 48,367 and 260,712 person-years follow-up, respectively. The crude incidence rate ratios for first severe infection and infection-related mortality were 2.59 (95% CI, 2.39-2.80) and 2.20 (95% CI, 1.76-2.73), respectively. The corresponding adjusted hazard ratios were 1.82 (95% CI 1.66-1.99) and 1.61 (95% CI, 1.24-2.08). SLE patients had an increased risk of a greater total number of severe infections with crude rate ratio of 3.24 (95% CI, 3.06-3.43) and adjusted rate ratio of 2.07 (95% CI, 1.82-2.36).

Conclusion:

SLE is associated with increased risks of first severe infection (1.8-fold), a greater total number of severe infections (2.1-fold) and infection-related mortality (1.6-fold).

References:

[1]Yurkovich M, Vostretsova K, Chen W, Aviña-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2014;66(4):608-16.

[2]Petri M. Infection in systemic lupus erythematosus. Rheum Dis Clin North Am 1998;24(2):423-56.

[3]Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003;82(5):299-308.

[4]Goldblatt F, Chambers S, Rahman A, Isenberg DA. Serious infections in British patients with systemic lupus erythematosus: hospitalisations and mortality. Lupus 2009;18(8):682-9.

[5]Bosch X, Guilabert A, Pallares L, et al. Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients. Lupus 2006;15(9):584-9.

Disclosure of Interests:

None declared