Incidence and variables associated with short and long-term mortality in patients with systemic lupus erythematosus and sepsis admitted in intensive care units

Abstract

Background

Infections are common among patients with systemic lupus erythematosus (SLE), and are associated with increased morbidity and mortality.

Objectives

To determine whether SLE is an independent risk factor for short- and long-term mortality in patients admitted to an intensive care unit (ICU) with sepsis, and to identify the characteristics of SLE patients admitted to an ICU with sepsis.

Methods

A retrospective age- and sex-matched cohort study, based on data of the SEPSIS-ISR (Sepsis Israel) Registry, an ongoing study that collects data on all patients admitted with sepsis to the ICUs. The primary outcome was to determine whether SLE is an independent risk factor for 30-day and 3-year mortality. Secondary outcomes were 30-day and 3-year survival rates, and the identification of variables associated with mortality within the group of patients with SLE.

Results

In total, 29 SLE and 87 non-SLE patients (median age 55 years; 79.3% females) were included. The primary sites of infection as well as pathogen distributions were similar between the two groups. The most common infections among the SLE and non-SLE patients were pneumonia (48.3 vs. 31%, p = 0.09), urinary tract infection (20.7 vs. 14.9%, p = 0.56) and peritonitis (13.8 vs. 16.1%, p = 0.77). Severe sepsis and septic shock were diagnosed in 79.3 versus 80.5% (p = 0.89) and 55.2 versus 33.3% (p = 0.04) of the SLE and non-SLE patients, respectively. The 30-day and 3-year survival rates did not differ between SLE and non-SLE patients, and were 69 versus 67.8% (p = 0.79) and 41.4 versus 47.1% (p = 0.69), respectively. In multivariate Cox regression analysis, age (hazard ratio (HR) = 1.02; 95% confidence interval (CI) 1.00–1.05) and cardiovascular involvement during sepsis (HR = 3.32; 95% CI 1.4–7.86) were significant independent risk factors for 30-day mortality. Multiorgan dysfunction during sepsis admission was associated with increased 3-year mortality (HR = 1.37; 95% CI 1.07–1.75).

Conclusions

SLE is not an independent risk factor for 30-day or 3-year mortality following ICU admission with sepsis. Increased late mortality was associated with congestive heart failure within the SLE patients alone. None of the SLE-related variables were statistically different between the living and deceased SLE patients.

Keywords

Systemic lupus erythematosus sepsis mortality infections

Get full access to this article

View all access options for this article.

References

Abu-Shakra

Novack

. Mortality and multiple causes of death in systemic lupus erythematosus – role of the death certificate. J Rheumatol 2012; 39: 458–460.

Ippolito

Petri

. An update on mortality in systemic lupus erythematosus. Clin Exp Rheumatol 2008; 26: S72–S79.

Fei

Shi

Gan

et al.

Death causes and pathogens analysis of systemic lupus erythematosus during the past 26 years. Clin Rheumatol 2014; 33: 57–63.

Murray

Schmajuk

Trupin

et al.

National lupus hospitalization trends reveal rising rates of herpes zoster and declines in pneumocystis pneumonia. PLoS One 2016; 11: e0144918–e0144918.

Barrett

Abramovich

Dreiher

et al.

Mortality due to sepsis in patients with systemic lupus erythematosus and rheumatoid arthritis. Isr Med Assoc J 2014; 16: 634–635.

Ruiz-Irastorza

Olivares

Ruiz-Arruza

Martinez-Berriotxoa

Egurbide

Aguirre

. Predictors of major infections in systemic lupus erythematosus. Arthritis Res Ther 2009; 11: R109–R109.

Noël

Lortholary

Casassus

et al.

Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001; 60: 1141–1144.

Vincent

J-L

Sakr

Sprung

et al.

Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med 2006; 34: 344–353.

Dreiher

Almog

Sprung

et al.

Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: A multicenter analysis. Crit Care Med 2012; 40: 855–860.

10.

Hodgin

Moss

. The epidemiology of sepsis. Curr Pharm Des 2008; 14: 1833–1839.

11.

Petri

Orbai

Alarcón

et al.

Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677–2686.

12.

Charlson

Pompei

Ales

et al.

A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987; 40: 373–383.

13.

Gladman

Ginzler

Goldsmith

. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996; 39: 363–369.

14.

Chen

Tseng

Huang

et al.

Long-term outcome and short-term survival of patients with systemic lupus erythematosus after bacteraemia episodes: 6-yr follow-up. Rheumatology (Oxford) 2008; 47: 1352–1357.

15.

Wang

Szychowski

Griffin

et al.

Long-term mortality after community-acquired sepsis: A longitudinal population-based cohort study. BMJ Open 2014; 4: e004283–e004283.

16.

Abu-Shakra

. Do improved survival rates of patients with systemic lupus erythematosus reflect a global trend? J Rheumatol 2008; 35: 1906–1908.

17.

Bui

Horwich

Fonarow

. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 2011; 8: 30–41.

18.

Singer

Deutschman

Seymour

et al.

The Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801–810.

19.

Martin

Mannino

Eaton

et al.

The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546–1554.