Serious Infections in Children With Lupus

Abstract

Research Article| July 01 2017 Serious Infections in Children With Lupus AAP Grand Rounds (2017) 38 (1): 10. https://doi.org/10.1542/gr.38-1-10 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Serious Infections in Children With Lupus. AAP Grand Rounds July 2017; 38 (1): 10. https://doi.org/10.1542/gr.38-1-10 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: systemic lupus erythematosus Source: Hiraki LT, Feldman CH, Marty FM, et al. Serious infection rates among children with systemic lupus erythematosus enrolled in Medicaid. Arthritis Care Res. 2017 Feb 19 [published online ahead of print]; doi: https://doi.org/10.1002/acr.23219Google Scholar Researchers from multiple institutions conducted a retrospective cohort study to determine the rate of serious infection among pediatric patients with systemic lupus erythematosus (SLE). By using a national Medicaid administrative database that included billing claims for Medicaid enrollees from 47 states and the District of Columbia from 2000 to 2006, all children aged 4–17 years with SLE were identified if they had ≥3 International Classification of Diseases, Ninth Revision (ICD-9) codes for SLE at least 30 days apart. Among those with SLE, children with lupus nephritis (LN) were also identified by using ICD-9 codes. The date that child participants met the criteria for SLE or LN was considered the index date. The primary outcome was serious infections, defined as infections requiring hospitalization. Serious infections were identified from discharge diagnosis ICD-9 codes beginning the day after the index date. Infections were categorized as bacterial, fungal, viral, or mycobacterial. Researchers calculated the number of serious infections among participants from their index date of diagnosis of SLE or LN to yield incidence rates per 100 person-years (PY) overall and stratified according to demographics. There were 3,500 children identified with SLE, 1,297 of whom also had LN. Overall, 87% of infections were bacterial, with the most common bacterial infections being pneumonia, bacteremia, and cellulitis. There were 1,053 serious infections identified among those with SLE, for an incidence rate of 10.42 per 100 PY, with significantly increased rates among children 9–12 years old when compared to those 5–8 years old (incidence rate ratio [IRR], 1.44) and among African American (IRR, 1.83) and Native American (IRR, 1.81) children when compared to white children. There were 624 serious infections identified among those with LN, for an incidence rate of 17.65 per 100 PY, with significantly increased rates among African American (IRR, 1.71) and Hispanic (IRR, 1.44) children when compared to white children. The researchers conclude that serious infections are common among children with SLE, with increased incidence among those with LN and minorities. Dr Higgins has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The current investigation, conducted by using a Medicaid database, is the first large population study in the United States to show the magnitude of increased risk of infection in childhood SLE. Most of the patients with SLE who were hospitalized for infection had only one serious infection during the 6 years that were analyzed, but a subset of patients, particularly those with LN, had ≥3 serious infections. It is not known whether pediatric patients with SLE with non-Medicaid medical coverage have a similarly increased risk of serious infection, though it seems likely. Unlike an analysis of adult Medicaid patients with SLE1 that contained 10 times as... You do not currently have access to this content.