1559. Risk factor, Characteristic and Outcome of Invasive Aspergillosis 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
  • poster-ia-IDSA2013.pdf (615.9 kB)
  • Background:

    Invasive aspergillosis (IA) is a significant cause of infectious complication among immunocompromised host but the knowledge of the risk factors and impact of the infection among patients with systemic lupus erythematosus (SLE) is limited. 

    Methods:

    We retrospectively reviewed cases of hospitalized SLE patients of the Faculty of Medicine, Ramathibodi Hospital between January 1st 2007 and December 31st 2012. We described clinical characteristics and outcome of SLE patients who developed IA. We also performed an unmatched case control study to explore risk factors of IA among SLE patients. The IA was defined using the EORTC/MSG criteria.

    Results:

    During the study period, the cumulative incidence of  IA was 2.8%. Of the 20 IA cases (30% definite and 70 % probable), patients’ median age (IQR) was 42.5 (26.3-54.8) years and 10% were male. Major underlying diseases were diabetes mellitus (15%), liver cirrhosis (10%). The major organ disorder of SLE was renal (95%) and hematology (80%). For IA, pulmonary was the major organ involvement (70%), followed by CNS (15%). Disseminated disease occurred in 10 %. All received systemic antifungal treatment. Co-infection occurred in 85% and included CMV infection (30%), bacterial infection (75%), tuberculosis (15%) and strongyloidiasis (5%). The median duration of hospitalization was 32.5 (20.25-49.75) days in survived group. Mortality rate after the IA diagnosis was 70%. Univariate analysis showed that associated factors of IA in SLE patients included a high Systemic Lupus Erythematosus Disease Activity Index scores [OR 1.1 (95% CI 1.02-1.18)], a higher accumulative dose of prednisolone (per 10 mg increment of prednisolone dosage) within 1 and 3 months duration [OR 1.04 (95%CI 1.02-1.06)] and [OR 1.01 (95%CI 1-1.02), respectively], pulse methylprednisolone [OR 74.67, 95%CI 12.15-368.6] and pulse cyclophosphamide [OR 28, 95%CI 6.46-121.3].  However, from multivariate analysis, a higher accumulative dose of prednisolone within 1 month duration was the only factor that was significantly associated with IA [P=0.005, OR 1.05 (95% CI 1.02-1.09].   

    Conclusion:

    IA is a major cause of invasive fungal infection among SLE patients with a high mortality rate. Our study is the first to show the associate risk factors and underscore the concept of target preventive strategy among high risk SLE populations.

    Siriorn Watcharananan, MD, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand and Teewin Rakyhao, M.D., Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Disclosures:

    S. Watcharananan, None

    T. Rakyhao, None

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