Risk factors for infections in systemic lupus erythematosus: a meta-analysis

Immune dysfunction in patients with systemic lupus erythematosus (SLE) increases susceptibility to infections, complicating their management. Identifying risk factors for infections is essential for improving clinical outcomes. A meta-analysis was conducted to evaluate factors associated with infection risk in patients with SLE. Relevant studies were retrieved from PubMed, Web of Science, Embase, and Scopus databases from inception to November 2023. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using R software (version 4.3.1). Factors analyzed included age, gender, active disease stage, diabetes mellitus, kidney injury, hydroxychloroquine, high-dose glucocorticoids, immunosuppressive drugs, lymphopenia, anti-dsDNA, and complement 3 (C3). Twenty-one studies were included. The analysis identified several factors significantly associated with increased infection risk: age (OR = 1.02, 95% CI 1.01-1.04), being male (OR = 1.66, 95% CI 1.19-2.33), active disease stage (OR = 1.74, 95% CI 1.25-2.43), diabetes mellitus (OR = 1.64, 95% CI 0.92-2.93), kidney injury (OR = 1.78, 95% CI 1.37-2.30), high-dose glucocorticoids (OR = 2.40, 95% CI 1.88-3.80), immunosuppressive drugs (OR = 2.24, 95% CI 1.15-4.38), lymphopenia (OR = 3.59, 95% CI 2.42-5.33), and low C3 (OR = 2.38, 95% CI 1.13-5.03). Older age, male gender, active disease, diabetes, kidney injury, high-dose glucocorticoid use, immunosuppressants, lymphopenia, and decreased C3 levels may increase the risk of infections in SLE. These findings highlight the importance of individualized infection prevention strategies in high-risk patients.