The Incidence of Hospital Stays due to Infection in Patients with Systemic Lupus Erythematosus at Chonburi Hospital and Associated Factors

Authors

  • Sittikorn Srivorrapattarakul Chonburi hospital

Abstract

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, and its treatment with immunosuppressive agents can increase the risk of infection, leading to hospitalization. Disease activity can also cause hospitalization, but it requires different treatment. In particular, infection is a curable condition. Some symptoms, such as fever, can be caused by both infection and disease activity. Being aware of the incidence of hospital stays due to infection can lead to timely awareness and the administration of empirical antibiotics when appropriate. The aims of this study were to estimate the incidence of hospital stays due to infection in patients with SLE and identify associated factors.

Methods: This was a retrospective cross-sectional study. Patients older than 18 years with diagnosed SLE in the Inpatient Department (IPD) at Chonburi Hospital were recruited from January 1, 2020, to January 1, 2022. Data on patient demographics, the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), reasons for hospitalization, medication, laboratory results, and discharge status were collected. Fischer's exact test or the Mann-Whitney U test was used to make appropriate comparisons between groups, and binary logistic regression was employed to determine associations.

Result: Among the 250 patients, the mean age was 38.7 years, and 87.6% were female. The incidence of hospital stays due to infection in patients with SLE was 25.6%. The most common cause of hospitalization was a disease flare (35.2%). Patients with hospital stays due to infection had a lower SLEDAI-2K score [Median (IQR), 1 (0, 8) vs. 7 (0, 14), p < 0.01], higher ESR [Median (IQR), 69 (41, 95) vs. 56 (33, 77), p = 0.03], longer hospital stays (more than seven days) [59.4% vs. 36.6% (n=66), p < 0.01], and a higher mortality rate [15.6% vs. 2.7%, p < 0.01] than the other group. This study showed that the following factors are associated with hospital stays due to infection: steroids at a dose of 10 mg/day or higher of prednisolone equivalent dose [adjusted OR 2.51, p = 0.04], Azathioprine [adjusted OR 4.01, p < 0.01], and anti-malarial agents [adjusted OR 0.28, p = 0.01].

Conclusions: The incidence of hospital stays due to infection in patients with SLE was 25.6%. The association between steroids at a dose of 10 mg/day or higher of prednisolone equivalent dose, azathioprine, and anti-malarial agents and hospital stays due to infection exists, but further study is needed to investigate this association more thoroughly.

Author Biography

Sittikorn Srivorrapattarakul, Chonburi hospital

Division of Rheumatology, Department of Medicine,

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Published

2024-01-04 — Updated on 2024-01-14

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