RT Journal Article
T1 Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus
A1 Rúa-Figueroa, Íñigo
A1 Galindo Izquierdo, María
A1 López Longo, Francisco Javier
A1 Andrés Gutiérrez, Mariano De
A1 Santos Montes, Gregorio Ángel
A1 Ibáñez Alonso, Jesús
A1 Pego-Reigosa, José M.
AB Objectives: To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort.Methods: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection.Results: A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999).Conclusions: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.
PB Elsevier
SN 0049-0172
YR 2017
FD 2017
LK https://hdl.handle.net/20.500.14352/114203
UL https://hdl.handle.net/20.500.14352/114203
LA eng
NO Rúa-Figueroa Í, López-Longo J, Galindo-Izquierdo M, Calvo-Alén J, Del Campo V, Olivé-Marqués A, Pérez-Vicente S, Fernández-Nebro A, Andrés M, Erausquin C, Tomero E, Horcada L, Uriarte E, Freire M, Montilla C, Sánchez-Atrio A, Santos G, Boteanu A, Díez-Álvarez E, Narváez J, Martínez-Taboada V, Silva-Fernández L, Ruiz-Lucea E, Andreu JL, Hernández-Beriain JÁ, Gantes M, Hernández-Cruz B, Pérez-Venegas J, Pecondón-Español Á, Marras C, Ibáñez-Barceló M, Bonilla G, Torrente V, Castellví I, Alegre JJ, Calvet J, Marenco JL, Raya E, Vázquez T, Quevedo V, Muñoz-Fernández S, Rodríguez-Gómez M, Ibáñez J, Pego-Reigosa JM. Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus. Semin Arthritis Rheum. 2017 Aug;47(1):38-45.
NO Spanish Foundation of Rheumatology.
NO FIS/ISCIII(Grantno.PI11/02857).
NO Dr.Pego-Reigosa is supported by Grant316265(BIOCAPS) from the European Union 7th Framework Programe (FP7/REGPOT-2012–2013.1).
DS Docta Complutense
RD 18 dic 2025