1548. Risk Factors of Cytomegalovirus Disease among Patients with Systemic Lupus Erythematosus
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID week 2013 poster final.pdf (290.0 kB)
  • Background: Among systemic lupus erythematosus (SLE) patients, cytomegalovirus (CMV) disease has increasing been recognized as an important infectious complication resulting in a high mortality rate but the risk factors of the disease remains unclear.

    Methods: We performed an unmatched case control study to identify risk factors of CMV disease among adult (age >15years old) SLE patients hospitalized during January 2005 and September 2012 at the Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand. The medical records were reviewed 3 months before and after the diagnosis of CMV disease (CMV group) and 3 months before and after the date of admission-free CMV disease (control group). Risk factors of CMV disease were finally determined by multivariate logistic regression analysis. The odds ratio (OR) with 95% confidence interval (CI) were calculated.

    Results: During the studied periods, CMV disease occurred in 50 patients. Patients’ median (interquartile range; IQR) age was 41.5 (27-51) years and majority (88%) was female. Median time (IQR) to diagnosis of CMV disease after intensive immunosuppressive therapy was 1.29 (0.76-1.85) months. CMV pneumonitis was the major (66%) clinical presentation. CMV viremia was common (91.3 %), with the median (IQR) initial blood CMV viral load of 17,100 (2,760-90,000) copies/ml. The overall mortality rate was high (58%). From multivariate analysis, risk factors of CMV disease included chronic kidney disease(CKD)  [OR 72.07, 95% CI 3.24-1605.16, p = 0.007], high Systemic Lupus Erythematosus disease activity index SLENA modification (SLEDAI score) (OR 1.15, 95% CI 1.05-1.3, p=0.005), oral prednisolone [ median (IQR) dosage (mg/day) of 54.18 (35.63-67.9) in CMV group VS. 11.33 (5-29.4) in  control group, respectively (OR 1.06, 95% CI 1.02-1.1, p=0.001)], pulse methylprednisolone (OR 11.32, 95% CI 2.23-57.56, p=0.003) and bacterial infection prior to CMV disease (OR 8.98, 95% CI 1.84-43.78, p=0.007). Further analysis showed that every 10 mg increment of daily prednisolone dosage within a 3-month period significantly increased risk of CMV disease (OR 2.12, 95% CI 1.63-2.76, p<0.001).

    Conclusion: Herein is the very first study showing risk factors of CMV disease in SLE patients. CMV preventive strategy among this high risk population is crucial to reduce morbidity and mortality from the infection.

    Pattraporn Ponglorpisit, MD, Siriorn Watcharananan, MD and Pintip Ngamjanyaporn, MD, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Disclosures:

    P. Ponglorpisit, None

    S. Watcharananan, None

    P. Ngamjanyaporn, None

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