Infections and Their Associations Among Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study in Sri Lanka
Desha Rajni Fernando, Akhila Imantha Nilaweera, Anusha Nimrod Perera, Pesala Randika Adikaranayake, Kumudu Chamodani Kariyawasam, Janani Vidarsha Liyanage, Dilushi Rowena Wijayaratne, Inoshi AtukoralaBackground:
Infections cause significant morbidity and mortality in systemic lupus erythematosus (SLE). This study describes infection prevalence, patterns, and their association with disease severity and flares in a single-centre Sri Lankan SLE cohort.
Methods:
This retrospective descriptive study at the National Hospital of Sri Lanka included SLE patients aged ≥14 years meeting American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (ACR/EULAR) criteria. Data on diagnosis, organ damage (Systemic Lupus International Collaborating Clinics [SLICC]/ACR Damage Index), treatment, flares, and infections were collected from medical records. Univariate logistic and Cox regression analyses assessed risk factors for infections, with odds ratio (OR) and hazard ratio (HR) reported with 95% CIs.
Results:
Two hundred patients (females = 92.5%; mean age = 37.3 years [SD = 2.1]; mean diagnosis age = 23.8 years; mean SDI = 3.38 [SD = 0.41]) were studied. Skin damage occurred in 59.5%. 47.0% had flares; median duration to first flare 67.5 months (IQR = 21.8–124.5). Infections occurred in 45.5% (rate 45.9/1000 patient-years). Infection risk increased with age (OR = 1.03,1.01–1.06), disease duration (OR = 1.03,1.01–1.06), damage score (OR = 1.2,1.04–1.34), flares (OR = 2.9,1.61–5.09) and comorbidities (OR = 2.1,1.20–3.75). Multiple analyses showed that flares (HR = 2.43,1.55–3.81) and the presence of comorbidities (HR = 1.64,1.03–2.62) increased infection hazard. 29.5% experienced infections while on prednisolone.
Conclusions:
This study found a high infection rate among patients with SLE, with increased risk associated with older age and longer disease duration. Modifiable factors, including steroid use, comorbidities, and disease flares, were also significantly associated with infections. Optimising disease control, minimising unnecessary steroid exposure, and appropriate management of comorbidities may help reduce the infection burden in SLE patients.