RESEARCH - Predictors of major infections in SLE

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Arthritis Research & Therapy 2009, 11:R109doi:10.1186/ar2764

Published: 15 July 2009

Predictors of major infections in systemic lupus erythematosus

Guillermo Ruiz-Irastorza , Nerea Olivares , Ioana Ruiz-Arruza ,

Agustin ez-Berriotxoa , - Egurbide and Ciriaco

Aguirre

Department of Internal Medicine, Hospital de Cruces, University of the

Basque Country, Pza Cruces s/n, 48903 Barakaldo, Bizkaia, Spain

Abstract

Introduction

Infections commonly complicate the course of systemic lupus

erythematosus (SLE). Our aim is to investigate the clinical predictors

of major infections in patients with SLE.

Methods

A nested case–control study design was used within the prospective

Lupus-Cruces cohort. The endpoints of the study were major infections.

Cases were defined as patients with a major infection. Two controls

(SLE patients without major infections), matched for time of follow-up

until the event and age at diagnosis, were selected for each case.

Univariate analysis and logistic regression models were used for the

analysis of data.

Results

Two hundred and forty-nine patients (83 cases, 166 controls) were

selected. Eighty-three episodes of major infections were analyzed; E.

coli, S. aureus, M. tuberculosis and S. pneumoniae being the most

frequent isolates. Univariate analysis identified several variables

related with infection: lung and renal involvement, at or previous to

the study point; leukopenia at the study point; antiphospholipid

antibody-positivity and treatment with prednisone within 3 months

previous to the study point, and the dose of prednisone received.

Treatment with antimalarials, on the other hand, showed a strong

inverse association with major infections. Logistic regression models

identified treatment with antimalarials (odds ratio (OR) = 0.06, 95%

confidence interval (CI) = 0.02 to 0.18), prednisone dose (OR = 1.12,

95% CI = 1.04 to 1.19) and lung involvement (OR = 4.41, 95% CI = 1.06

to 18.36) as significant and independent predictors of major

infections. No significant interactions among these three variables

were found. Further adjustment for potential confounders related with

antimalarial treatment did not change the results.

Conclusions

The risk of major infections in patients with SLE is mostly influenced

by treatment. Prednisone treatment, even at moderate doses, increases

the risk, whilst antimalarials have a protective effect.

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Read the full article here:

http://arthritis-research.com/content/11/4/R109

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