Risk factors for invasive fungal infections in patients with connective tissue disease: Systematic review and meta-analysis
Authors' conclusion
Diabetes, pulmonary disease, ILD, renal disease, use of GC (especially at moderate to high dose) and immunosuppressive drugs, and lymphopenia were found to be associated with significant risk for IFIs (especially PJP) in patients with CTD. Furthermore, the use of HCQ may reduce the risk of IFIs in patients with CTD.
Study context
- Population
- Patients with connective tissue disease (CTD); PubMed, Embase and Cochrane Library searched from inception to February 1, 202326 studies
- Comparison
- Potential risk factors vs their absence for invasive fungal infections (IFIs) in CTD
- Outcome
- Invasive fungal infections (IFIs)
Pooled result
As reported in the abstract
Risk factors for IFIs
Odds ratio (95% CI)
Diabetes
1.62(1.00–2.64)
Pulmonary diseases
3.43(2.49–4.73)
ILD
4.06(2.22–7.41)
Renal disease
4.41(1.84–10.59)
GC useespecially moderate to high-dose GC
4.15(2.74–6.28)
AZA use
1.50(1.12–2.01)
Calcineurin inhibitor use
2.49(1.59–3.91)
MMF use
2.83(1.59–5.03)
CYC use
3.35(2.47–4.54)
Biologics use
3.43(2.36–4.98)
Lymphopenia
4.26(2.08–8.73)
HCQ usereduced risk of IFIs
0.67(0.54–0.84)
Further pooled results
Risk factors for Pneumocystis jiroveci pneumonia (PJP)
- Pulmonary disease, interstitial lung disease (ILD), use of glucocorticoid (GC), calcineurin inhibitor (CNIs), CYC, methotrexate (MTX), mycophenolate mofetil (MMF) and biologics, and lymphopenia increased the risk of PJP
- Hydroxychloroquine (HCQ) use reduced the risk of PJP
- 17 of the 26 studies only reported risk factors for PJP
Original publication
Risk factors for invasive fungal infections in patients with connective tissue disease: Systematic review and meta-analysis. Semin Arthritis Rheum. Published 22 August 2023. doi:10.
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