National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia
National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia
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DOI：
10.1371/journal.pone.0144918
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发表时间：
2016-01-05
期刊：
影响因子：
3.7
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
--
作者：
Murray, Sara G.;Schmajuk, Gabriela;Yazdany, Jinoos
目的感染是系统性红斑狼疮(SLE)发病和死亡的主要原因。治疗实践在过去15年中有所发展，但对系统性红斑狼疮感染性并发症的影响尚不清楚。在一项基于人群的SLE研究中，我们评估了因严重和机会性感染而住院的趋势。方法数据来源于2000年至2011年美国国家住院患者样本，包括符合SLE有效管理定义的个人。主要诊断结果为菌血症、肺炎、机会性真菌感染、带状疱疹、巨细胞病毒或肺孢子虫肺炎(PCP)。我们使用泊松回归来确定SLE住院期间的感染率是否在变化，并使用预测性边际值来生成特定感染的年度调整比率。结果我们确定了2000至2011年间符合研究纳入标准的361,337例SLE住院患者。与非系统性红斑狼疮住院患者相比，SLE患者更年轻(51岁比62岁)，主要是女性(89%比54%)，并且更有可能是种族/少数民族。系统性红斑狼疮的诊断与所有被测量的严重和机会性感染显著相关。从2000年到2011年，调整后的带状疱疹系统性红斑狼疮住院率高于非系统性红斑狼疮住院率：每10,000例系统性红斑狼疮住院病例中有54至79例，而每10,000例非系统性红斑狼疮住院病例中有24至29例。相反，因PCP而住院的SLE患者不成比例地减少：每10,000例SLE住院患者中有5.1例至2.5例，而非SLE患者每10,000例非SLE患者中有0.9例至1.3例。这些趋势可能反映了SLE治疗策略的演变。需要进一步的研究来确定感染并发症风险最高的患者。
ObjectiveInfection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study.MethodsData derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections.ResultsWe identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations.ConclusionsAmong patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications.