Predicting Infection in Hospitalized Patients with Systemic Lupus Erythematosus

• Published in: Internal Medicine Vol. 35; no. 8; pp. 629 - 636
• Main Authors: YUHARA, Takamichi, TAKEMURA, Hiroyuki, AKAMA, Takao, SUZUKI, Hiroshi, YAMANE, Kazuhide, KASHIWAGI, Heihachiro
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 1996; Japanese Society of Internal Medicine
• Subjects: Adolescent; Adult; Biological and medical sciences; Cohort Studies; creatinine; Creatinine - blood; Female; Humans; Infection - blood; Infection - diagnosis; Infection - etiology; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Medical sciences; Models, Biological; Models, Statistical; prednisolone; Prednisolone - administration & dosage; Prednisolone - adverse effects; Retrospective Studies; risk factor; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; serum albumin; Serum Albumin - metabolism; Creatinine; Human; Immunopathology; Connective tissue disease; Corticosteroid; Skin disease; Prognosis; Autoimmune disease; Assay; Infection; Treatment; Systemic disease; Risk factor; Lupus erythematosus; Disseminated; Predictive factor; Prednisolone
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.35.629

To identify the risk factors for infection and to develop a model for the prediction of infection in hospitalized patients with active systemic lupus erythematosus (SLE), we carried out a retrospective cohort study with clinical data collected from 121 consecutive patients with active SLE. Seventeen patients had infection within 6 months of beginning steroid therapy for active SLE. Independent multivariate predictors of infection were a decrease in the serum albumin value, an increase in the serum creatinine value, and prednisolone use in a dose of ≥60 mg/day without methylprednisolone pulse therapy. The error rate of the model by 10-fold cross-validation method was 12%, sensitivity was 65%, specificity was 91%, and positive predictive value was 55%. Four nonsurvivors were correctly discriminated. Use of this model could contribute to earlier diagnosis of infection and may assist decisions regarding empiric antimicrobial administration in patients with SLE. (Internal Medicine 35: 629-636, 1996)