Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus

Objectives-To describe infectious complications and analyse their risk fact ors and prognostic role in adults with systemic lupus erythematosus (SLE). Methods-A monocentric cohort of 87 adults with SLE (1960-1997) was studied to determine the risk factors for infection (disease activity evaluated by SLAM and SLEDAI scores, type of organ(s) involved or any biological abnorma lity, specific treatments) by comparing patients who had suffered at least one infectious episode (n=35; 40%) with non-infected patients (n=52; 60%). Prognostic indicators were assessed by comparing survivors at 10 years with non-survivors. Results-Of the 57 infectious episodes, 47 (82%) were of bacterial origin, 1 6 (28%) were pneumonia, and 46 (81%) were community acquired. According to univariate analysis, significant risk factors for infection were: severe fl ares, lupus glomerulonephritis, oral or intravenous corticosteroids, pulse cyclophosphamide, and/or plasmapheresis. No predictors were identified at t he time of SLE diagnosis. Multivariate analyses retained intravenous cortic osteroids (p <0.001) and/or immunosuppressants (p <0.01) as independent ris k factors for infection, which was the only factor for death after 10 years of evolution (p <0.001). Conclusion-In adults with SLE, infections are common and most often caused by community acquired bacteria. Intravenous corticosteroids and immunosuppr essants are independent risk factors for infection, which is the only indep endent risk factor for death after 10 years of SLE evolution.