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LP-038 Infection in systemic lupus erythematosus-associated diffuse alveolar hemorrhage: a potential key to improve outcomes
  1. Mucong Li1,
  2. Wei Bai1,
  3. Yanhong Wang2,
  4. Lan Song3,
  5. Shangzhu Zhang1,
  6. Jiuliang Zhao1,
  7. Chanyuan Wu1,
  8. Mengtao Li1,
  9. Xinping Tian1 and
  10. Xiaofeng Zeng1
  1. 1Department of Rheumatology, Peking Union Medical College Hospital, China
  2. 2Department of Epidemiology and Biostatistics, Peking Union Medical College, China
  3. 3Department of Radiology, Peking Union Medical College Hospital, China


Background This study aimed to investigate the clinical characteristics, outcomes, and risk factors of patients with a rare but fatal manifestation of systemic lupus erythematosus (SLE), diffusive alveolar hemorrhage (DAH), stratified by infection status in a national representative cohort.

Methods This single-center retrospective study included 124 consecutive patients with SLE-DAH in a tertiary care center between 2006 to 2021. The diagnosis of DAH was made based on a comprehensive evaluation of clinical manifestations, laboratory and radiologic findings, and bronchoalveolar lavage. Demographics, clinical features, and survival curves were compared between patients with bacterial, non-bacterial, and non-infection groups. Univariate and multivariate logistic regression analysis were performed to determine the factors independently associated with bacterial infection in SLE-DAH.

Results Fifty-eight patients with SLE-DAH developed bacterial infection after DAH occurrence, thirty-two patients developed fungal and/or viral infection, and thirty-four patients were categorized as non-infection. The bacterial infection group have a worse prognosis (OR 3.059, 95%CI 1.469–6.369, p=0.002) compared with the other two groups, with a mortality rate of 60.3% within 180 days after DAH occurrence. Factors independently associated with bacterial infections in SLE-DAH included hematuria (OR 4.523, 95%CI 1.068–19.155, p=0.040), hemoglobin drop in the first 24 hours after DAH occurred (OR 1.056, 95%CI 1.001–1.115, p=0.049), and anti-Smith antibody (OR 0.167, 95%CI 0.052–0.535, p=0.003). Glucocorticoid pulse therapy and cyclophosphamide were administered in more than 50% of patients regardless of their infectious status. According to clinical experience at our hospital and in previous studies, we recommended a comprehensive management algorithm for SLE-DAH based on infection stratification.

Conclusions Infection, especially bacterial infection, is a severe complication and prognostic factor of SLE-DAH. Comprehensive management strategies, including diagnosis, evaluation, treatment, and monitoring, based on infection stratification may fundamentally improve outcomes of patients with SLE-DAH.

Comprehensive management algorithm for SLE-DAH. SLE, systemic lupus erythematosus; DAH, diffusive alveolar hemorrhage; HgB, hemoglobin; BALF, bronchoalveolar lavage fluid; Anti-Sm: anti-Smith antibodies; CTX, cyclophosphamide.

  • systemic lupus erythematosus
  • diffusive alveolar hemorrhage
  • bacterial infections

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