Infectious Complications in Lupus Nephritis and Associated Factors: A Multicenter Study

Abstract

Introduction: The prevalence of infections in patients with systemic lupus erythematosus ranges from 26% to 78%. Patients with systemic lupus erythematosus are particularly susceptible to infections due to a dysfunction of immune response and the immunosuppressive therapy. Patients and method: We carried out this study with the aim of describing the prevalence of infections in lupus nephritis and determining the associated risk factors. This was a multi-center, observational, retrospective, descriptive and analytical study over a 10-year period from November 1, 2010 to October 31, 2020. The study was carried out in the nephrology departments of six hospitals in Dakar. Results: During the study period, 98 patients were included. The mean age was 32.32 ± 11.33 years with a sex ratio of 0.21. Among the included patients, fifty-four (55.1%) had at least one infectious episode, of which 53.7% had 1 infection, 24.1% had 2 infectious episodes and 22.2% had 3 infectious episodes. The overall incidence was 55.1 infections per 100 patient-years. 57.2% of these infectious episodes occurred within the first six months after the lupus was diagnosed. The main sites of infection were urinary (30.7%), gastrointestinal (22.0%) and pleuropulmonary (16.5%). The incriminated germ was a bacterium in 78.18% of cases, a virus in 5.46%, a parasite in 9.09 and a fungus in 7.27. The most frequently germ found was Escherichia coli (29.09%). The evolution was marked by recovery in 93.4% of cases. Deaths occurred in 15 patients of which 33.3% were related to infections. Factor significantly associated with the onset of infection in multivariate analysis was the presence of a proliferative class of lupus nephritis (p = 0.013). Conclusion: Infections were common during lupus nephritis. The presence of a proliferative class was risk factors for infection.