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[Infections in systemic lupus erythematosus].
L Massardo1, M E Martínez, M Baro
1Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago.
Revista Medica De Chile
|October 1, 1991
Summary
Infections are a significant cause of mortality in systemic lupus erythematosus (SLE), often linked to aggressive steroid therapy, not immunosuppression levels. Aggressive steroid use increases risks, especially for severe infections like pneumonia and septicemia.
Area of Science:
- Rheumatology
- Infectious Diseases
- Clinical Medicine
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
- Infections are a major cause of morbidity and mortality in SLE patients.
- The role of immunosuppressive therapy and steroid use in SLE-related infections requires further elucidation.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of major infections in a cohort of SLE patients.
- To determine the relationship between infection, disease activity, treatment regimens (steroids, immunosuppressors), and mortality in SLE.
- To identify risk factors associated with fatal infections in SLE.
Main Methods:
- Retrospective review of 159 patients with SLE followed for 18 years.
- Analysis of infection incidence (per 100 patient-years), clinical features, microbiological data, and treatment details.
- Comparison of characteristics between patients with and without infections, and between those with fatal versus non-fatal infections.
Main Results:
- Major infections occurred in 78 patients (20/100 pt-years).
- Infections were associated with higher rates of proteinuria, CNS involvement, methylprednisolone boluses, and mortality.
- Infection risk was independent of steroid or immunosuppressant dosage but associated with repeated infections; 84% of infections occurred during steroid therapy.
- Gram-negative enterobacteria were common isolates; pulmonary infections occurred in 30%.
- Fatal infections (19 patients) were linked to pneumonia and septicemia, often with high-dose steroid use (> or = 40 mg), with no clear relation to immunosuppression.
- Opportunistic pathogens were found in 26% of cases, associated with high-dose steroids.
Conclusions:
- Infections remain a critical cause of mortality in SLE, despite improved survival.
- Aggressive steroid therapy, particularly high-dose regimens, is strongly associated with infection risk and mortality in SLE patients.
- While immunosuppression is linked to recurrent infections, high-dose steroid use appears more directly implicated in fatal outcomes and opportunistic infections.