Risk Factors for Skin Infection in Patients with Systemic Lupus Erythematosus (SLE)

Abstract

Background: Systematic lupus erythematosus (SLE) is an autoimmune chronic disease that sometimes leads to serious life-threatening condition. The occurrence of SLE was about 5 million worldwide by 2022. The overall frequency of SLE across Asian countries ranged from 0.9 to 3.1 per 100,000. Infection is one of the grave condition in SLE patients. This study intended to evaluate risk factors for skin infections in patients with systematic lupus erythematosus. Material & Methods: This observational prospective study was carried out in the Department of Rheumatology, BSMMU, Dhaka, Bangladesh from November 2014 to April 2016. A total of 131 patients with systematic lupus erythematosus were enrolled in this study as study subjects following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Proper written consent was taken from all the participants, before recruiting. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Univariate and multivariate analyses were performed to identify the predictive of infection in patients with systemic lupus erythematosus (SLE) where P<0.05 was considered as the level of significance with 95%CI. Results: Among the total study population (N=131), skin infections were found in 27% of cases (n=35) whereas 73% of cases were non-infected (n=96). In the infected group, the mean age of the respondents was 28.2±8.7 years. Taeniasis was the most common skin infection (15, 42.9%), and herpes infection was found in 12 patients (34.3%). Higher SELENA SLEDAI scores were more frequent in skin infected group than that in the non-infected group. Skin infections were significantly higher among the participants who used I.V. cyclophosphamide. In skin infected group, immunosuppressive drugs were used significantly in higher frequency (94.3% versus 24.0%) than in the non-infected group. In the multivariate analysis, higher disease activity (SELENA-SLEDAI score >3, (P=0.049) (OR=21.44), higher daily doses of prednisolone intake (>10mg/day, P=0.046) (OR=16.69), low serum C3/C4 (P=0.004) (OR=147.82) and use of any immunosuppressive drugs either in present or previously (P value= 0.042) (OR=22.58) were found as significant risk factors. Conclusion: In this study, taeniasis and herpes infections were found as the most common skin infections among patients with systemic lupus erythematosus (SLE). Higher disease activity, a higher dose of prednisolone, use of any immunosuppressive therapy either present or past and low complement level were the risk factors for skin infections.