Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

Abstract

Objective

To evaluate the risk of major infections in children with newly diagnosed childhood-onset systemic lupus erythematosus (cSLE).

Methods

Predictors of major infections were identified by the multivariable logistic regression. Major infection free was defined as no major infection events within 6 months after the diagnosis of cSLE. The Kaplan–Meier survival plot was performed. A prediction model for major infection events was established and examined by receiver operating characteristic (ROC) curve analysis.

Results

A total of 98 eligible patients were recorded in the medical charts. Sixty-three documented events of major infections were found in 60 (61.2%) cSLE patients. Furthermore, 90.5% (57/63) of infection events occurred within the first 6 months after the diagnosis of cSLE. The high SLEDAI (SLEDAI >10), lupus nephritis and lymphocyte count <0.8×109/L were predictors for major infections. The CALL score (Children with high disease activity [SLEDAI >10], lymphopenia, and LN) was defined by the number of predictors. Patients were then categorized into two groups: low-risk (score 0–1) and high-risk (score 2–3). Patients in the high-risk group had higher rates of the major infection occurrence than those in the low-risk group during the 6 months after the diagnosis of the cSLE (P<0.001) (HR:14.10, 95% CI 8.43 to 23.59). The ROC curve analysis indicated that the CALL score was effective both in the whole cSLE cohort [area under the curve (AUC) = 0.89, 95% CI: 0.81–0.97] and in the subgroup of lung infections (n = 35) (AUC = 0.79, 95% CI: 0.57–0.99).

Conclusion

High disease activity, LN and lymphopenia were predictors for major infections in newly diagnosed cSLE patients. Specific predictors help identify the cSLE patients with the high risk of major infections. The CALL score could be a useful tool to stratify cSLE patients in practice.

Keywords:

• lupus
• infection
• pediatrics

Data Sharing Statement

Data are available on reasonable request. Researchers need to send requests with protocols to the corresponding authors to gain access.

Ethical Approval and Consent

This was a study based on a retrospective chart review. The trial protocol was approved by the ethics committee of Shanghai Children’s Medical Center (SCMCIRB-K2022068-1) and the study was carried out in accordance with the Declaration of Helsinki. Written informed consent was obtained from the parents/guardians.

Acknowledgment

Shengfang Bao and Jingyi Lu contributed equally to this work and share first authorship.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Clinical Research Center For Systemic Lupus Erythematosus, Pediatric College, Shanghai Jiao Tong University School of Medicine (ELYZX202102).