Predictors of major infections in systemic lupus erythematosus

Introduction Infections commonly complicate the course of systemic lupus erythematosus (SLE). Our aim is to investigate the clinical predictors of major infections in patients with SLE. Methods A nested case-control study design was used within the prospective Lupus-Cruces cohort. The endpoints of the study were major infections. Cases were defined as patients with a major infection. Two controls (SLE patients without major infections), matched for time of follow-up until the event and age at diagnosis, were selected for each case. Univariate analysis and logistic regression models were used for the analysis of data. Results Two hundred and forty-nine patients (83 cases, 166 controls) were selected. Eighty-three episodes of major infections were analyzed; E. coli, S. aureus, M. tuberculosis and S. pneumoniae being the most frequent isolates. Univariate analysis identified several variables related with infection: lung and renal involvement, at or previous to the study point; leukopenia at the study point; antiphospholipid antibody-positivity and treatment with prednisone within 3 months previous to the study point, and the dose of prednisone received. Treatment with antimalarials, on the other hand, showed a strong inverse association with major infections. Logistic regression models identified treatment with antimalarials (odds ratio (OR) = 0.06, 95% confidence interval (CI) = 0.02 to 0.18), prednisone dose (OR = 1.12, 95% CI = 1.04 to 1.19) and lung involvement (OR = 4.41, 95% CI = 1.06 to 18.36) as significant and independent predictors of major infections. No significant interactions among these three variables were found. Further adjustment for potential confounders related with antimalarial treatment did not change the results. Conclusions The risk of major infections in patients with SLE is mostly influenced by treatment. Prednisone treatment, even at moderate doses, increases the risk, whilst antimalarials have a protective effect

Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.

ObjectiveTo analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia.MethodsComparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation.ResultsWe included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91-27.86), HR 10.09 (95% CI 2.14-47.50), HR 4.14 (95% CI 0.81-21.23), respectively, for death; HR 7.38 (95% CI 1.86-29.29), HR 13.71 (95% CI 3.76-50.07), HR 3.58 (95% CI 0.89-14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2.ConclusionsWeek-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point

BIOLOGICS USE in SLE in 23 CENTERS - DATA FROM the INTERNATIONAL REGISTRY for BIOLOGICS in SLE

Karolinska Univ Hosp, Stockholm, SwedenRigshosp, DK-2100 Copenhagen, DenmarkCedars Sinai UCLA, Los Angeles, CA USADalhousie Univ & Capital Hlth, Halifax, NS, CanadaJohns Hopkins Univ Hosp, Baltimore, MD 21287 USAUCL, London, EnglandMcGill UHC RI, Montreal, PQ, CanadaMcGill Univ, Ctr Hlth, Montreal, PQ, CanadaMcGill UHC RVH, Montreal, PQ, CanadaKarolinska Inst, Stockholm, SwedenHanyang Univ, Hosp Rheumat Dis, Seoul 133791, South KoreaHosp Clin Barcelona, Barcelona, SpainHosp Cruces, Bizkaia, SpainHosp Virgen Rocio, Seville, SpainHosp Miguel Servet, Zaragoza, SpainHosp San Cecilio, Granada, SpainHosp Son Dureta, Palma de Mallorca, SpainHosp Carlos Haya, Malaga, SpainIstanbul Univ, Istanbul Fac Med, Istanbul, TurkeyNorthwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USAUniv Manitoba, Winnipeg, MB, CanadaCareggi Hosp Florence, Florence, ItalyUniv Szeged, Szeged, HungaryUniv Padua, Padua, ItalyUniv Debrecen, H-4012 Debrecen, HungaryHlth Sci Ctr, Debrecen, HungaryUniv Cattolica Sacro Cuore, Div Rheumatol, I-00168 Rome, ItalyCatholic Univ, Rheumatol Unit, Rome, ItalyUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc