Hospitalization and Mortality due to Infection among United States Children and Adolescents with Systemic Lupus Erythematosus.

Abstract

We aimed to determine the frequency and types of infections in hospitalized children with childhood-onset systemic lupus erythematosus (cSLE), and to identify risk factors for intensive care unit (ICU) admission and mortality. We conducted a retrospective study of youth 2-21 years of age with ICD codes for SLE during admission to a hospital participating in the Pediatric Health Information System, a database of United States children's hospitals, from 2009-2021. Generalized linear mixed effect models were used to identify risk factors for ICU admission and mortality among children hospitalized with infection. We identified 8,588 children with cSLE and ≥ 1 hospitalization. Among this cohort, there were 26,269 hospitalizations, of which 13% had codes for infections, a proportion which increased over time (p = 0.036). Bacterial pneumonia was the most common hospitalized infection. In-hospital mortality occurred in 0.4% (n=103) of cSLE hospitalizations for any indication and 2% of hospitalizations for infection (n=60). The highest mortality rates occurred with pneumocystis jirovecii pneumonia (21%) and other fungal infections (21%). Lupus nephritis and end-stage renal disease (ESRD) were associated with increased odds of ICU admission (OR [95% CI] 1.47 [1.2- 1.8]) and 2.4 [1.7-3.4]) among children admitted for serious infection. ESRD was associated with higher mortality, OR 2.34 [1.1-4.9]. Hospitalizations with codes for for infection comprised a small proportion of cSLE admissions but accounted for the majority of mortality. The proportion of hospitalizations for infection increased over time. Lupus nephritis and ESRD were risk factors for poor outcomes.