A NEW study brought to light significant risks associated with infections in children and adolescents with childhood-onset systemic lupus erythematosus (cSLE). The research analysed data from the Paediatric Health Information System spanning 2009–2021, examined the frequency and types of infections among hospitalised cSLE patients and identified key risk factors for intensive care units admission and mortality.
The study reviewed 26,269 cases of hospitalisations in 8,588 children with cSLE and found that 13% of these hospitalisations were due to infections, a proportion that has increased over time. The most common infection leading to hospitalisation was bacterial pneumonia. While the overall in-hospital mortality rate for cSLE patients was 0.4%, this figure jumped to 2% when the hospitalisation was due to infection. The deadliest infections were Pneumocystis jirovecii pneumonia and other fungal infections, both associated with a mortality rate of 21%.
Further analysis revealed that children with lupus nephritis and end-stage renal disease (ESRD) were at a higher risk of severe outcomes when hospitalised for infections. Specifically, these conditions were linked to increased odds of requiring ICU admission, with ESRD doubling the risk of mortality in these patients.
This study highlights the need for vigilant infection management in children with cSLE, particularly those with underlying kidney complications like lupus nephritis and ESRD. As the proportion of hospitalisations due to infections continues to rise, the study emphasises the importance of early intervention and targeted care strategies to improve outcomes for these young patients.
Aleksandra Zurowska, EMJ
Reference
Roberts J E et al. Hospitalization and Mortality Due to Infection Among Children and Adolescents With Systemic Lupus Erythematosus in the United States. J Rheumatol. 2024; https://doi.org/10.3899/jrheum.2023-1219.
