Serious infections and tuberculosis adversely impact outcomes of juvenile onset systemic lupus erythematosus in India
Authors' conclusion
Serious infections are a major cause of mortality and damage in SLE. Constitutional symptoms, gastrointestinal involvement, current and cumulative steroid dose and cyclophosphamide predict serious infections.
Study context
- Population
- Children with juvenile systemic lupus erythematosus (SLE) (ACR 1997 criteria), age <18 years, rheumatology clinic at a single centre in India, 2000–2020197 girls
- Participants
- 225 children
- Outcome
- Incidence of serious infection (need for hospitalization, or infection resulting in disability or death)
Methodological detailssingle-centre, Cox regression
- Single-centre
- Cox regression
Main finding
As reported in the abstract
Serious infections
- Children with ≥1 serious infection
- 63 (28%)
- Serious infections, total
- 80
- Serious infection rate per 1000 person-years
- 69.35
- Cumulative follow-up, person-years
- 1153.45
- Serious infection-free survival at 1 year
- 84% (79.1-89.2)
- Serious infection-free survival at 5 years
- 72% (65.4-79.2)
Observational data: associations, not effects.
Further findings
Factors associated with serious infection (multivariate analysis)
- Fever, HR
- 8.51, 1.17-61.44
- Gastrointestinal involvement, HR
- 4.73, 1.13-19.94
- Current steroid dose, HR
- 1.36,1.14-1.62
- Average cumulative steroid dose per year, HR
- 1.004, 1.002-1.005
- Cyclophosphamide, HR
- 2.22, 1.11-4.46
Infection etiology
- Known etiology, % of cases
- 78.75%
- Bacterial infections
- 33
- Opportunistic infections
- 26 (32.5%)
- Mycobacterium tuberculosis
- 18
- Extrapulmonary tuberculosis
- 15 (83.3%)
Hospitalization rate, any serious infection vs none
- Rate-ratio
- 2.79, 1.81-3.77
Damage accrual (SLICC damage index), serious infection vs none
- SLICC damage index 1.04 vs 0.22
Mortality
- Deaths
- 19
- Infection-attributable deaths
- 10 (52.6%)
- Recurrent infections, HR for overall mortality
- 36.02 (8.07-160.62)
Original publication
Serious infections and tuberculosis adversely impact outcomes of juvenile onset systemic lupus erythematosus in India. Lupus. Published 17 December 2024. doi:10.
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