Abstract
Objective Infectious risk in immunocompromised patients, particularly if affected by Systemic Lupus Erythematosus (SLE), is associated with disease-related and treatment-related factors. We analyze the rate of severe infections (defined as severe if immunosuppressive therapy has to be interrupted and/or patient has to be hospitalized for intravenous/oral therapy) in our cohort of SLE patients to identify risk factors for the development of infections.
Methods In our cohort we have enrolled 74 SLE patients (8 M, 66 F), of which 54 (72.97%; 5 M, 49 F) in actual or previous immunosuppressive therapy, with a median age of 45.71 years (SD +- 15.59 years). Patients who discontinued immunosuppressive treatment for severe infections were 20 (38.46% of patients on immunosuppressive therapy, 27.02% of the total cohort, 17 F and 3 M).
11/20 (55%) patients experienced Herpes Zoster, 8/20 (40%) Covid19 infection and 8/20 (40%) other types of infections (enteritis, urinary tract infections, extra-pulmonary tuberculosis, pneumonia and cellulitis). Herpes zoster was the most frequent severe infection in our cohort.
All patients with severe infections required immediate discontinuation of immunosuppressive therapy; 4/20 experienced a disease flare (20%), 19/20 (95%) required specific therapy for infection treatment, 7/20 (35%) required hospitalization and intravenous antibiotic/antiviral therapy.
We have conducted a comparison with the cohort of patients on immunosuppressive therapy who did not experience severe infections; we have also analyzed the different types of immunosuppressive treatment and cardiovascular risk factors in the two cohorts.
Results From our data analysis, conducted with statistical tests (t-Test, Fisher exact test, p-value 0.05) with the R-project software, there is no significant difference about specific risk factors that could favour the occurrence of severe infectious disease between patients in immunosuppressive therapy. Data analysis also highlighted that mycophenolate or belimumab increase infective risk.
Conclusions In our cohort we did not identify specific risk factors for severe infections in immunosuppressed patients. Analysis of larger cohorts has to be encouraged to identify potential risk factors for severe infections, so that they could be treated or prevented without treatment discontinuation.
