Mortality due to sepsis in patients with systemic lupus erythematosus and rheumatoid arthritis. Academic Article uri icon

abstract

  • The survival rate of patients with SLE has improved significantly over the last five decades, from less than 50% at 5 years in 1955 to 85% at 10 years in recent studies [1]. This improvement in SLE survival rates is the result of a continuously increasing survival in the general population, advances in therapeutic modalities, more judicious use of existing therapies (particularly steroids and cytotoxic agents), and the change in prognostic factors. Despite this encouraging progress, patients with SLE followed at various centers in North America have a 2.4 to threefold increased risk of death compared with the general population. This increased mortality is the result of infections, cardiovascular disease, and irreversible damage to target organs [1]. Infections contribute significantly to the morbidity and mortality of patients with SLE. It is estimated that at least 50% of SLE patients will suffer a severe infectious episode during the course of their disease [2]. Up to 30% of deaths in SLE are due to infections, although a recent mortality study from Hong Kong showed infection to be the main cause of death in 60% of the cases [3]. Similar to infections in the general population, major infections in SLE include common infectious diseases, such as pneumonia, urinary tract infection, cellulites and septicemia. In addition, patients with SLE are susceptible to infections associated with immune suppression, including opportunistic infections, tuberculosis, herpes zoster, as well as disseminated infections. In a study from Sao Paulo, the observed number of deaths due to tuberculosis, septicemia and pneumonia was significantly higher among SLE patients as compared to ageand gender-matched controls [1]. Identifying predictor variables for major infection in SLE is crucial for developing management plans to further improve the survival of SLE patients. A wide range of demographic, clinical and laboratory variables have been associated with increased risk of infections in SLE. These include low socioeconomic status, race, nephritis, antiphospholipid syndrome, high disease activity, damage measures and many others. The degree of immunosuppression and SLE disease are among the most important of those variables [4]. The clinical features of very active SLE may mimic those of infection and occasionally it is difficult to distinguish between SLE infection and SLE flare. Early diagnosis and treatment of a suspected infectious process is highly important since a delay in diagnosis may result in a rapid and fatal course.

publication date

  • January 1, 2014