Risk factors associated with infections in pregnant women with systemic lupus erythematosus

Valviesse, Daniele Maia de Jesus; Monteiro, Denise Leite Maia; Jésus, Nilson Ramires de; Jésus, Guilherme Ribeiro Ramires de; Santos, Flavia Cunha; Lacerda, Marcela Ignacchiti; Rodrigues, Nadia Cristina Pereira; Klumb, Evandro Mendes

doi:10.1590/1806-9282.20220074

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 68 (4) • Apr 2022 • https://doi.org/10.1590/1806-9282.20220074 copy

Risk factors associated with infections in pregnant women with systemic lupus erythematosus

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to analyze the occurrence and risk factors associated with infections during pregnancy in patients with systemic lupus erythematosus.

METHODS:

This is a retrospective cohort study using the data of pregnant women who were followed up between 2011 and 2018 at a university hospital.

RESULTS:

The data of 221 pregnant women with systemic lupus erythematosus were analyzed. The incidence of infections was 22.6% (50/221), with the urinary tract being the most frequent site of infection (32/221, 14.5%) followed by the respiratory tract (15/221, 6.8%). The bivariate analysis showed that active disease, hematological systemic lupus erythematosus, reduced complement, and use of prednisone ≥5 and ≥10 mg increased the chance of infection during early pregnancy (p=0.05, p=0.04, p=0.003, p=0.008, and p=0.02, respectively), while disease activity and anti-DNA positivity increased it at the end of pregnancy (p=0.03 and p=0.04, respectively). Prednisone at a dose ≥5 mg increased the chance of infection in the beginning (p=0.01) and at the end of pregnancy (p=0.008). Multivariate analysis showed that increasing the dose of prednisone from 5 to 10 mg tripled the chance of developing infections in pregnant women with lupus (p=0.02).

CONCLUSION:

The study showed an increased chance of infections in pregnant women with systemic lupus erythematosus and it was associated with the use of prednisone.

KEYWORDS:
Systemic lupus erythematosus; Infection; Pregnancy; Risk factors

Clinical/laboratory variables
Variables			Infection	Without infection	p-value
Variables			n (%)	n (%)	p-value
Cutaneous mucous SLE		Present	44 (19.9)	149 (67.4)	0.87
Cutaneous mucous SLE		Absent	6 (2.71)	22 (9.95)
Hematological SLE		Present	35 (15.8)	93 (43.0)	0.04^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
Hematological SLE		Absent	15 (67.9)	78 (35.3)
Renal SLE		Present	21 (9.5)	77 (34.8)	0.7
Renal SLE		Absent	29 (13.1)	94 (42.5)	0.7
Neuropsychiatric SLE		Present	13 (5.9)	31 (14.3)	0.22
Neuropsychiatric SLE		Absent	37 (16.7)	140 (63.3)	0.22
Joint SLE		Present	48 (21.7)	154 (69.6)	0.19
Joint SLE		Absent	2 (0.9)	17 (7.7)	0.19
Serositis		Present	19 (8.6)	60 (27.1)	0.7
Serositis		Absent	31 (14.0)	111 (50.2)	0.7
Initial C3 and/or C4		Consumed	22 (9.9)	47 (21.3)	0.03^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
Initial C3 and/or C4		Normal	28 (12.7)	124 (56.1)
Final C3 and/or C4		Consumed	15 (6.8)	43 (19.5)	0.49
Final C3 and/or C4		Normal	35 (15.8)	128 (57.9)	0.49
Initial Anti-DNA		Positive	21 (9.5)	49 (22.2)	0.07
Initial Anti-DNA		Negative	29 (13.1)	122 (55.2)	0.07
Final Anti-DNA		Positive	26 (11.8)	61 (27.6)	0.04^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
Final Anti-DNA		Negative	24 (10.9)	110 (49.8)
Initial SLEPDAI		≥3	22 (9.9)	50 (22.6)	0.05
Initial SLEPDAI		<3	28 (12.7)	121 (54.8)
Final SLEPDAI		≥3	23 (10.4)	55 (24.9)	0.44
Final SLEPDAI		<3	27 (12.2)	116 (54.5)	0.44
Medications:
	Prednisone	Present	38 (17.2)	98 (44.3)	0.02^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
	Prednisone	Absent	12 (5.4)	73 (33.0)
	Final prednisone	Present	39 (17.6)	98 (4.4)	0.008^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
	Final prednisone	Absent	11 (5.0)	73 (33.0)
	Initial prednisone ≥ 5 mg/day	Present	37 (16.7)	93 (42.1)	0.01^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
	Initial prednisone ≥ 5 mg/day	Absent	13 (5.8)	78 (35.3)
	Final prednisone ≥ 5 mg/day	Present	37 (16.7)	91 (41.2)	0.008^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
	Final prednisone ≥ 5 mg/day	Absent	13 (5.8)	80 (36.2)
	Initial prednisone ≥ 10 mg/day	Present	22 (9.9)	46 (20.8)	0.02^* * Systemic Lupus Erythematosus Prenancy Disease Activity Index.
	Initial prednisone ≥ 10 mg/day	Absent	28 (12.7)	125 (56.6)
	Final prednisone ≥ 10 mg/day	Present	23 (10.4)	54 (24.4)	0.06
	Final prednisone ≥ 10 mg/day	Absent	27 (12.2)	117 (51.5)	0.06
	Initial prednisone ≥ 40 mg/day	Present	3 (1.4)	10 (4.5)	0.93
	Initial prednisone ≥ 40 mg/day	Absent	47 (21.3)	161 (72.8)	0.93
	Final prednisone ≥ 40 mg/day	Present	3 (1.4)	15 (6.8)	0.56
	Final prednisone ≥ 40 mg/day	Absent	47 (21.3)	156 (70.6)	0.56
	Initial hydroxychloroquine	Present	46 (20.8)	159 (72)	0.79
	Initial hydroxychloroquine	Absent	4 (1.8)	12 (5.4)	0.79
	Final hydroxychloroquine	Present	48 (21.7)	169 (76.5)	0.26
	Final hydroxychloroquine	Absent	2 (0.9)	2 (0.9)	0.26
	Initial azathioprine	Present	21 (9.5)	62 (28.1)	0.46
	Initial azathioprine	Absent	29 (13.1)	109 (49.3)	0.46
	Azatioprina final	Present	27 (1.2)	71 (32.1)	0.12
	Azatioprina final	Absent	23 (10.4)	100 (45.2)	0.12

		Crude OR (95%CI)	p-value	Adjusted OR	p-value
Initial SLEPDAI^* * Log transformation. Logistic regression models whose response variable was “infection in general.” The explanatory variables of the multiple model were initial SLEPDAI and final prednisone. SLEPDAI; Pregnancy-adapted SLE Disease Activity Index.		1.28 (0.88–1.81)	0.21	1.01 (0.65–1.57)	0.96
Initial SLEPDAI^* * Log transformation. Logistic regression models whose response variable was “infection in general.” The explanatory variables of the multiple model were initial SLEPDAI and final prednisone. SLEPDAI; Pregnancy-adapted SLE Disease Activity Index.		1.24 (0.88–1.75)	0.21
Initial prednisone (mg)
	0	1
	5	2.32 (0.98–5.47)	0.05
	10	3.25 (1.39–7.62)	0.01
	40	2.18 (0.52–9.17)	0.29
Final prednisone (mg)
	0	1
	5	2.82 (1.17–6.80)	0.02	3.05 (1.20–7.77)	0.02
	10	3.27 (1.41–7.57)	0.01	3.15 (1.22–8.12)	0.02
	40	1.49 (0.37–5.99)	0.57	1.57 (0.35–7.02)	0.56
Initial azathioprine (mg)
	0	1
	50	0.51 (0.06–4.24)	0.53
	100	2.09 (0.97–4.48)	0.06
	150	0.82 (0.28–2.36)	0.71
	200	3.44 (0.72–16.5)	0.12
Final azathioprine (mg)
	0	1
	50	1.37 (0.41–4.58)	0.61
	100	1.19 (0.51–2.80)	0.68
	150	1.08 (0.37–3.16)	0.89
	200	2.06 (0.18–23.5)	0.56

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author: danimaia2909@gmail.com