Background The aim of this cohort study is to explore whether zoster infection could increase the risk of flares in patients with systemic lupus erythematosus.
Methods Patients who had zoster infection between January 2013 and April 2018 were included from the SLE database of Shanghai Ren Ji Hospital, South Campus. Patients with bacterial infections including urinary tract infection and bacterial pneumonia were selected as controls. Severe infections including fungi infections and septic shock were excluded. Besides, 200 SLE patients at the same time were set as general populations by systemic sampling. Baseline period was defined as three months before infections or admissions for general population, and risk period was within three months after infections or admissions. Characteristics and treatment strategies of baseline period including gender, age, disease duration, average daily dose of prednisone and immunosuppressive agents were collected. Flare was defined by SELENE SLEDAI criterion. Flare free survival was assessed by Kaplan-Meier curve. Cox regression analysis was performed to identify risk factors of flares.
Results 33 with zoster infections, 18 with urinary tract infections and 7 patients with bacterial pneumonia were identified in this period. 13 relapses in 11 patients were observed, but there were only 3 relapses in bacterial infection group. Kaplan Meier curve showed that compared to general population, more patients with a recent history of zoster infection within 3 months had a flare (33.3% vs 9%, p=0.0034), while bacterial infections did not seem to affect the flare rate (12% vs 9%, p=0.4755). Furthermore, after adjusting important covariates, cox regression analysis confirmed that prior zoster infection within three months was a risk factor of flares in SLE patients (p<0.001, HR 4.7).
Conclusions In patients with SLE, recent zoster infection within three months may be associated with increased risk of flares.
Funding Source(s): Kaplan Meier Curve of patients in three groups
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