Introduction
Materials and methods
Study design and patients
Study endpoint
Statistical analysis
Results
Demographic data
Frequency and types of major infections
Number of cases | % | |
---|---|---|
Pneumonia | 34 | 41 |
Bacteremia | 20 | 24 |
Cellulitis and skin abscess | 8 | 10 |
Tuberculosis | 6 | 7 |
Meningitis–encephalitis | 5 | 6 |
Pyelonephritis | 4 | 5 |
Abdominal infections | 3 | 4 |
Esophageal candidiasis | 1 | 1 |
Osteomyelitis | 1 | 1 |
Disseminated Varicella | 1 | 1 |
Microorganism | Number of cases | % |
---|---|---|
Escherichia coli
| 7a | 16 |
Staphylococcus aureus
| 6a | 14 |
Mycobacterium tuberculosis
| 6 | 14 |
Streptococcus pneumoniae
| 5 | 12 |
Salmonella | 4 | 9 |
Psuedomonas aeruginosa
| 3 | 7 |
Candida albicans
| 3 | 7 |
Neisseria meningitides
| 2 | 5 |
Varicella Zoster virus | 2 | 5 |
Campylobacter | 1 | 2 |
Legionella | 1 | 2 |
Herpes simplex virus | 1 | 2 |
Serratia | 1 | 2 |
Staphylococcus epidermidis
| 1 | 2 |
Aspergillus | 1 | 2 |
Predictors of major infection
Major infection (n = 83) | No major infection (n = 166) | P value | |
---|---|---|---|
Female sex | 73/83 (88) | 150/166 (90) | 0.70 |
Nephritis at study point | 15/83 (18) | 10/166 (6) | <0.01 |
Previous nephritis | 34/83 (41) | 39/166 (23) | <0.01 |
Thrombocytopenia at study point | 6/83 (7) | 7/166 (4) | 0.50 |
Previous thrombocytopenia | 19/83 (23) | 27/166 (16) | 0.27 |
Lung disease at study point | 12/83 (14) | 6/166 (4) | <0.01 |
Previous lung disease | 13/83 (15) | 8/166 (5) | <0.01 |
Leukopenia at study point | 32/83 (39) | 23/166 (14) | <0.01 |
Low complement at study point | 36/81 (44) | 52/163 (32) | 0.08 |
Anti-DNA antibodies | 61/83 (73) | 102/166 (61) | 0.08 |
Antiphospholipid antibodies | 43/83 (52) | 57/166 (34) | 0.01 |
SDI = 0 | 57/83 (69) | 125/166 (75) | |
SDI = 1 to 2 | 22/83 (26) | 38/166 (23) | 0.29 |
SDI >2 | 4/83 (5) | 3/166 (2) | |
SLEDAI at diagnosis | 10 (1 to 25) | 9 (1 to 22) | 0.23 |
SLEDAI at study point | 4 (0 to 24) | 3 (0 to 21) | 0.15 |
SLEDAI at diagnosis >12 | 25/81 (31) | 33/163 (20) | 0.09 |
SLEDAI at study point >12 | 5/81 (6) | 7/163 (4) | 0.74 |
Antimalarials | 18/83 (22) | 128/166 (77) | <0.01 |
Months on antimalarials | 0 (0 to 300) | 24 (0 to 192) | <0.01 |
Azathioprine | 16/83 (19)a | 20/166 (12) | 0.18 |
Methotrexate | 2/83 (3) | 13/166 (8) | 0.12 |
Cyclophosphamide | 3/83 (4) | 2/166 (1) | 0.42 |
Mycophenolate | 1/83 (1) | 5/166 (3) | 0.66 |
Cyclosporine | 3/83 (2)a | 4/166 (5) | 0.34 |
Any immunosuppressor | 23/83 (30) | 44/166 (26) | 0.96 |
Prednisone | 62/83 (75) | 90/166 (54) | <0.01 |
Prednisone dose (mg/day) | 7.5 (0 to 90) | 2.5 (0 to 60) | <0.01 |
Variable | Odds ratio | 95% confidence interval |
---|---|---|
Lung involvement at study point | 4.41 | 1.06 to 18.36 |
Prednisone dose (mg/day) | 1.12 | 1.04 to 1.19 |
Antimalarials | 0.06 | 0.02 to 0.18 |
Antiphospholipid antibodies | 1.88 | 0.66 to 5.32 |
Antiphospholipid antibodies × antimalarials | 2.21 | 0.52 to 9.33 |
Antiphospholipid antibodies × prednisone dose | 0.98 | 0.88 to 1.11 |
Influence of disease severity on antimalarial treatment and its effect on major infections
Antimalarials | P value | ||
---|---|---|---|
Yes (n = 146) | No (n = 103) | ||
Age at diagnosis (years) | 34 (14) | 40 (18) | <0.01 |
Female sex | 131/146 (89) | 63/103 (86) | 1.00 |
Nephritis ever | 35/146 (24) | 50/103 (48) | <0.01 |
Lung involvement ever | 11/146 (7.5) | 13/103 (12.6) | 0.26 |
Thrombocytopenia ever | 24/146 (16) | 17/103 (26) | 0.08 |
Leukopenia ever | 94/146 (64) | 85/103 (82) | <0.01 |
Anti-DNA antibodies ever | 96/146 (66) | 67/103 (65) | 1.00 |
Low complement at study point | 48/143 (34) | 40/101 (40) | 0.40 |
Prednisone at study point | 89/146 (61) | 63/103 (62) | 1.00 |
Azathioprine at study point | 18/146 (12) | 18/103 (18) | 0.34 |
Cyclophosphamide at study point | 2/146 (1) | 3/103 (3) | 0.69 |
Methotrexate at study point | 12/146 (8) | 3/103 (3) | 0.144 |
Mycophenolate at study point | 6/146 (45) | 0/103 (0) | 0.04 |
SDI = 0 | 121/146 (83) | 61/103 (59) | |
SDI = 1 to 2 | 25/146 (17) | 35/103 (34) | 0.001 |
SDI >2 | 0/146 (0) | 7/103 (7) | |
SLEDAI at diagnosis | 9 (1 to 22) | 9 (2 to 25) | 0.94 |
SLEDAI at study point | 4 (0 to 21) | 3 (0 to 24) | 0.84 |
SLEDAI at diagnosis >12 | 33/143 (23) | 25/101 (25) | 0.88 |
SLEDAI at study point >12 | 6/143 (4) | 6/101(6) | 0.75 |
Variable | Odds ratio | 95% confidence interval |
---|---|---|
Lung involvement at study point | 3.11 | 0.79 to 12.31 |
Prednisone dose (mg/day) | 1.10 | 1.04 to 1.17 |
Antimalarials | 0.07 | 0.03 to 0.15 |
Age at diagnosis | 0.99 | 0.97 to 1.01 |
Leukopenia ever | 1.99 | 0.82 to 4.82 |
Nephritis ever | 1.61 | 0.72 to 3.64 |
Mycophenolate at study point | 1.52 | 0.15 to 15.40 |
SDI = 0 | Reference | |
SDI = 1 to 2 | 0.42 | 0.18 to 1.00 |
SDI > 2 | 0.22 | 0.03 to 1.65 |