Infection in systemic lupus erythematosus-associated diffuse alveolar hemorrhage: a potential key to improve outcomes.
Bacterial infections
Diffusive alveolar hemorrhage
Systemic lupus erythematosus
Journal
Clinical rheumatology
ISSN: 1434-9949
Titre abrégé: Clin Rheumatol
Pays: Germany
ID NLM: 8211469
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
29
08
2022
accepted:
17
01
2023
revised:
21
12
2022
medline:
24
5
2023
pubmed:
17
2
2023
entrez:
16
2
2023
Statut:
ppublish
Résumé
This study aimed to investigate the clinical characteristics, outcomes, and associated factors of patients with systemic lupus erythematosus-associated diffusive alveolar hemorrhage (SLE-DAH) stratified by infection status in a national representative cohort. This single-center retrospective study included 124 consecutive patients with SLE-DAH in a tertiary care center between 2006 and 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 analyses were performed to determine the factors independently associated with bacterial infection in SLE-DAH. 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 h 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. 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. Key Points • Bacterial infection is an important, but neglected, prognosis factor of systemic lupus erythematosus (SLE)-associated diffusive alveolar hemorrhage (DAH). • Hematuria, hemoglobin drop, and anti-Smith antibody can independently predict bacterial infections in SLE-DAH. • We put forward a comprehensive management algorithm based on infection stratification for SLE-DAH.
Identifiants
pubmed: 36797549
doi: 10.1007/s10067-023-06517-8
pii: 10.1007/s10067-023-06517-8
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1573-1584Subventions
Organisme : Chinese National Key Technology R&D Program, Ministry of Science and Technology
ID : 2021YFC2501301-5
Organisme : Chinese National Key Technology R&D Program, Ministry of Science and Technology
ID : 2017YFC0907601-3
Organisme : Beijing Municipal Science & Technology Commission
ID : No.Z201100005520022
Organisme : Beijing Municipal Science & Technology Commission
ID : 23
Organisme : Beijing Municipal Science & Technology Commission
ID : 25-27
Organisme : CAMS Innovation Fund for Medical Sciences (CIFMS)
ID : 2021-I2M-1-005
Informations de copyright
© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).
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