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FRI0549 (2020)
RISK OF INVASIVE FUNGAL INFECTION IN SYSTEMIC LUPUS ERYTHEMATOSUS: A NATIONWIDE POPULATION-BASED STUDY IN TAIWAN
C. F. Su1, C. C. Lai1, T. H. LI2, Y. F. Chang3, Y. T. Lin4, C. Y. Tsai1, Y. S. Chang5
1Taipei Veterans General Hospital, Department of Medicine, Division of Allergy, Immunology, Rheumatology, Taipei, Taiwan, Republic of China
2Taichung Veterans General Hospital, Chiayi Branch, Department of Medicine, Division of Allergy, Immunology, Rheumatology, Taipei, Taiwan, Republic of China
3Taipei Veterans General Hospital, Department of Ophthalmology, Taipei, Taiwan, Republic of China
4Taipei Veterans General Hospital, Department of Medicine, Division of Infectious Diseases, Taipei, Taiwan, Republic of China
5Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan, Republic of China

Background: Infectious disease is one of the leading causes of mortality in systemic lupus erythematosus (SLE). Among these infections, invasive fungal infection (IFI) carries high mortality rate (25-70%), but the literature of IFI in SLE is limited.


Objectives: To investigate the epidemiology and risk factors of invasive fungal infection and its subtypes, including candidiasis, aspergillosis, and cryptococcosis, in SLE patients.


Methods: All patients with newly diagnosed SLE between 1997-2012 were enrolled from Taiwan National Health Insurance Research Database, with an age- and sex-matched non-SLE control group in a ratio of 1:10. IFI was identified by ICD9 codes 1 from discharge record and validated by use of systemic anti-fungal agents. The incidence rate (IR), incidence rate ratio (IRR), cause mortality rate of IFI and its subtypes were compared. A Cox multivariate model with time-dependent covariates was applied to analyse the independent risk factors of IFI.


Results: A total of 269 951 subjects (24 541 SLE and 245 410 control) were included. There were 445 episodes of IFI in SLE group. Candida was the most common pathogen (52.8%), followed by cryptococcus and aspergillus. The IR of IFI in SLE was 20.83 per 10,000 person-years with an IRR of 11.1 (95% CI 9.8-12.6) compared to the control (figure 1). Kaplan-Meier curve also disclosed a lower IFI-free survival in SLE (figure 2). The all-cause mortality rate was similar between SLE and the control (26.7 vs 25.7%). In SLE, treatment with mycophenolate mofetil (HR=2.24, 95% CI 1.48-3.37), cyclosporin (HR=1.65, 95% CI 1.10-1.75), cyclophosphamide (HR=1.37, 95% CI 1.07-1.75), oral daily dose of steroid>5 mg prednisolone (HR=1.26, 95% CI 1.01-1.58), and intravenous steroid therapy (HR=29.11, 95% CI 23.30-36.37) were identified as independent risk factors of IFI. Similar analyses were performed for subtypes of IFI. Distinctive risk factors were found between different subtypes of IFI (table 1).


Conclusion: SLE patients have a higher risk of IFI. Intravenous steroid therapy is the most important risk factor of IFI. This study provides crucial information for risk stratification of IFI in SLE.


REFERENCES:

[1] Winthrop KL, Novosad SA, Baddley JW, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. 2015 Dec; 74(12):2107-2116.


Disclosure of Interests: None declared

Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 872
Session: Epidemiology, risk factors for disease or disease progression (Poster Presentations)