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Kachaner A, Mageau A, Timsit JF, Rio J, Papo T, Sacré K. SLE patients with childhood-onset: A nation-wide population-based study. Autoimmun Rev 2025; 24:103802. [PMID: 40081727 DOI: 10.1016/j.autrev.2025.103802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 03/10/2025] [Accepted: 03/10/2025] [Indexed: 03/16/2025]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that typically affects women of childbearing age. Using a nationwide database, we aimed to assess the prevalence, main clinical features and outcomes of patients with childhood-onset SLE (cSLE). Data on all patients admitted to a French hospital between January 2011 and December 2020 with at least one ICD, 10th revision code for SLE were retrieved from the nationwide hospital medical information database. Individuals who developed systemic SLE before the age of 17 years were considered to have cSLE. Between 2011 and 2020, 36,791 unique SLE patients were hospitalised in France. Among them, 1030 individuals younger than 17 years (median [q1-q3] age 13.0 [11.0;15.0]) years, 81.9 % female) were identified as having cSLE. The prevalence of cSLE was 8.3 cases per 100,000 inhabitants. The main characteristics of cSLE did not differ by sex, except for a younger age of onset in boys. Older children have a higher incidence of lupus nephritis. Compared to adult-onset SLE, lupus nephritis and immune cytopenia were twice as frequent in cSLE. During a median follow-up of 7.1 [4.0-9.0] years, 539 (52.3 %) cSLE patients experienced at least one hospitalisation for an infection. A total of 6 patients (0.6 %) died. All of these deaths occurred during the hospitalisation in which the first lupus code was assigned. The prevalence of cSLE in France was 8.3 cases per 100,000 of the population. cSLE had a higher rate of renal nephritis and immune cytopenia than adult-onset SLE.
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Affiliation(s)
- Alexandra Kachaner
- Département de Médecine Interne, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Départment de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Arthur Mageau
- Départment de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; IAME Inserm UMR 1137, Team DESCID, Faculté de Médecine Bichat, Université Paris Cité, Paris, France
| | - Jean-François Timsit
- IAME Inserm UMR 1137, Team DESCID, Faculté de Médecine Bichat, Université Paris Cité, Paris, France
| | - Julien Rio
- Département d'Information Médicale, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Thomas Papo
- Départment de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Laboratoire d'Excellence Inflamex, Université Paris Cité Paris, France
| | - Karim Sacré
- Départment de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Laboratoire d'Excellence Inflamex, Université Paris Cité Paris, France.
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Fagbenro A, Amadi ES, Uwumiro FE, Nwebonyi SO, Edwards QC, Okere MO, Awala SV, Falade I, Ekpunobi CA, Ekezie CE, Uboh EE, Adjei-Mensah J, Osemwota O. Rates, Diagnoses, and Predictors of Unplanned 30-Day Readmissions of Critical Care Survivors Hospitalized for Lung Involvement in Systemic Lupus Erythematosus: An Analysis of National Representative US Readmissions Data. Cureus 2024; 16:e73099. [PMID: 39650958 PMCID: PMC11621573 DOI: 10.7759/cureus.73099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2024] [Indexed: 12/11/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that frequently involves the lungs, contributing to significant morbidity in hospitalized patients. Critical care survivors with lung involvement in SLE are at particularly high risk for unplanned hospital readmissions, which can reflect the complexity of their disease, which often affects multiple organs and requires immunosuppressive therapy that increases infection risk. Severe pulmonary complications, critical illness sequelae, and challenges in medication adherence or follow-up care further contribute to their vulnerability. These factors result in frequent complications and flare-ups, making unplanned readmissions common in this population. This study assessed rates, most common reasons, and predictors of all-cause and SLE-related 30-day readmission among critically ill patients hospitalized for lung involvement in SLE. METHODS We analyzed the 2021 National Readmissions Database. Critically ill non-elective adult hospitalizations for lung involvement in SLE were identified for analysis using a combination of the ICD-10 diagnostic code for SLE with lung involvement (M32.13) and presence of any procedure codes for mechanical ventilation, tracheostomy, extracorporeal membrane oxygenation, or bronchoscopy. Non-lung-related SLE admissions, non-SLE-related lung disorders, patients with concomitant COPD, history of COVID-19 or severe asthma, patients transferred in from other hospitals or admitted for <24 hours, and patients with a DNR order were excluded. We used χ2 tests to compare baseline characteristics between readmissions and index hospitalizations. Stata ranking commands were used to identify the most recurrent diagnoses associated with 30-day readmissions. We used multivariate Cox regression analysis to identify independent predictors of readmissions. RESULTS Out of 3,472 index hospitalizations analyzed, 2,641 were discharged alive. Five hundred ninety-three (593; 22.5%) readmissions occurred within 30 days. Lung involvement in SLE was the most common reason for readmission (137; 23.1% of readmissions). Approximately 31.9% (189) of readmissions were due to other SLE-related complications. Readmissions were associated with higher inpatient mortality (18 (3.1%) versus 43 (1.6%); P=0.022), longer hospital stay (8 versus 5.2 days; P<0.001), younger mean age (26 versus 31 years; P=0.010), higher mean hospital costs (US $84,830 versus $64,628; P<0.001), and higher prevalence of heart failure (146 (24.6%) versus 526 (19.6%); P=0.024), CKD (435 (73.3%) versus 1,573 (58.6%); P<0.001), and anemia (138 (23.2%) versus 432 (16.1%); P=0.003) compared with index hospitalizations. Age ≥60 years (adjusted hazard ratio (AHR): 1.22; P=0.028), multiple (≥3) procedures during the initial admission (AHR: 2.57; P=0.003), discharge AMA (AHR: 1.68; P=0.047), lack of insurance/self-pay (AHR: 1.23; P=0.034), another coexisting autoimmune disorder (AHR: 1.19; P=0.041), index hospitalizations in the highest income quartile (AHR: 2.05; P=0.006), hyperlipidemia (AHR: 1.89; P=0.026), coexisting kidney disease (AHR: 1.56; P=0.017), and heart failure (AHR: 1.11; P=0.031) were significantly correlated with 30-day readmissions. CONCLUSIONS SLE lung readmissions were associated with worse outcomes than index hospitalization. Age ≥60 years, multiple procedures, discharge AMA, lack of insurance, kidney disease, and heart failure are significant predictors of readmission.
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Affiliation(s)
- Adeniyi Fagbenro
- Internal Medicine, Bowen University College of Health Sciences, Iwo, NGA
| | - Emmanuel S Amadi
- Internal Medicine, Hallel Hospital Port Harcourt, Port Harcourt, NGA
| | - Fidelis E Uwumiro
- Internal Medicine, Prime Healthcare-Southern Regional Georgia (SRGA), Riverdale, USA
| | | | | | - Madeleine O Okere
- Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
| | | | - Ifeoluwa Falade
- General Practice, Mersey and West Lancashire Teaching Hospitals, Boston, GBR
| | | | | | - Emah E Uboh
- Internal Medicine, College of Medicine, University of Lagos, Lagos, NGA
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Yang J, Chen J, Zhang M, Zhou Q, Yan B. Prognostic impacts of repeated sepsis in intensive care unit on autoimmune disease patients: a retrospective cohort study. BMC Infect Dis 2024; 24:197. [PMID: 38350868 PMCID: PMC10863122 DOI: 10.1186/s12879-024-09072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Autoimmune diseases (ADs) may be complicated by sepsis when intensive care unit (ICU) admission. But repeated sepsis among AD patients has not been studied yet. The aim of this study is to investigate the impact of repeated in-ICU sepsis on the 1-year overall-cause mortality, septic shock and in-ICU death of AD patients. METHODS Data of AD patients with sepsis retrieved from Medical Information Mart for Intensive Care IV (MIMIC-IV) database were divided into the single group and the repeated group according to the frequency of in-ICU sepsis. Propensity score matching was used to balance inter-group bias. Cox proportional hazard regression and sensitivity analysis were utilized to assess the variables on mortality. RESULTS The incidence of repeated in-ICU sepsis in baseline was 19.8%. The repeated in-ICU sepsis was a risk factor for 1-year overall-cause mortality among AD patients (adjusted hazard ratio [HR] = 1.50, 95% CI: 1.16-1.93, P = 0.002), with robust adjusted HRs by the adjustment for confounders in the sensitivity analysis (all P < 0.01). Maximum Sequential Organ Failure Assessment (Max SOFA), Charlson comorbidity index (CCI) and Simplified Acute Physiology Score-II (SAPS-II) were risk factors for 1-year overall-cause mortality among AD with repeated sepsis (Max SOFA: HR = 1.09, P = 0.002; CCI: HR = 1.08, P = 0.039; SAPS-II: HR = 1.03, P < 0.001). CONCLUSIONS Compared to single hit, repeated in-ICU sepsis was independently related to a higher risk of 1-year overall-cause mortality among AD patients. Assessment tools (Higher SOFA, CCI and SAPS-II scores) were closely linked to poor prognosis of AD with repeated sepsis and helped to reflect ill physical conditions for the patients.
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Affiliation(s)
- Jinming Yang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Jie Chen
- Department of Rheumatology, People's Hospital of Leshan, Leshan, China
| | - Min Zhang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Qingsa Zhou
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China
| | - Bing Yan
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No.37 Guoxue Alley, 610041, Chengdu, China.
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Singh P, Mohsin M, Sultan A, Jha P, Khan MM, Syed MA, Chopra M, Serajuddin M, Rahmani AH, Almatroodi SA, Alrumaihi F, Dohare R. Combined Multiomics and In Silico Approach Uncovers PRKAR1A as a Putative Therapeutic Target in Multi-Organ Dysfunction Syndrome. ACS OMEGA 2023; 8:9555-9568. [PMID: 36936296 PMCID: PMC10018728 DOI: 10.1021/acsomega.3c00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Despite all epidemiological, clinical, and experimental research efforts, therapeutic concepts in sepsis and sepsis-induced multi-organ dysfunction syndrome (MODS) remain limited and unsatisfactory. Currently, gene expression data sets are widely utilized to discover new biomarkers and therapeutic targets in diseases. In the present study, we analyzed MODS expression profiles (comprising 13 sepsis and 8 control samples) retrieved from NCBI-GEO and found 359 differentially expressed genes (DEGs), among which 170 were downregulated and 189 were upregulated. Next, we employed the weighted gene co-expression network analysis (WGCNA) to establish a MODS-associated gene co-expression network (weighted) and identified representative module genes having an elevated correlation with age. Based on the results, a turquoise module was picked as our hub module. Further, we constructed the PPI network comprising 35 hub module DEGs. The DEGs involved in the highest-confidence PPI network were utilized for collecting pathway and gene ontology (GO) terms using various libraries. Nucleotide di- and triphosphate biosynthesis and interconversion was the most significant pathway. Also, 3 DEGs within our PPI network were involved in the top 5 significantly enriched ontology terms, with hypercortisolism being the most significant term. PRKAR1A was the overlapping gene between top 5 significant pathways and GO terms, respectively. PRKAR1A was considered as a therapeutic target in MODS, and 2992 ligands were screened for binding with PRKAR1A. Among these ligands, 3 molecules based on CDOCKER score (molecular dynamics simulated-based score, which allows us to rank the binding poses according to their quality and to identify the best pose for each system) and crucial interaction with human PRKAR1A coding protein and protein kinase-cyclic nucleotide binding domains (PKA RI alpha CNB-B domain) via active site binding residues, viz. Val283, Val302, Gln304, Val315, Ile327, Ala336, Ala337, Val339, Tyr373, and Asn374, were considered as lead molecules.
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Affiliation(s)
- Prithvi Singh
- Centre
for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohd Mohsin
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Armiya Sultan
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Prakash Jha
- Laboratory
of Molecular Modeling and Anticancer Drug Development, Dr. B. R. Ambedkar
Center for Biomedical Research, University
of Delhi, New Delhi 110007, India
| | - Mohd Mabood Khan
- Department
of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - Mansoor Ali Syed
- Department
of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Madhu Chopra
- Laboratory
of Molecular Modeling and Anticancer Drug Development, Dr. B. R. Ambedkar
Center for Biomedical Research, University
of Delhi, New Delhi 110007, India
| | - Mohammad Serajuddin
- Department
of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - Arshad Husain Rahmani
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Saleh A. Almatroodi
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Faris Alrumaihi
- Department
of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ravins Dohare
- Centre
for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
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McPeake J, Bateson M, Christie F, Robinson C, Cannon P, Mikkelsen M, Iwashyna TJ, Leyland AH, Shaw M, Quasim T. Hospital re-admission after critical care survival: a systematic review and meta-analysis. Anaesthesia 2022; 77:475-485. [PMID: 34967011 DOI: 10.1111/anae.15644] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.
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Affiliation(s)
- J McPeake
- Intensive Care Unit, Glasgow Royal Infirmary and School of Medicine, Dentistry and Nursing, University of Glasgow, UK
| | - M Bateson
- University of the West of Scotland, Glasgow, UK
| | - F Christie
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Robinson
- Belfast Health and Social Care Trust, Belfast, UK
| | - P Cannon
- University of Glasgow Library, Glasgow, UK
| | - M Mikkelsen
- Center for Clinical Epidemiology and Biostatistics, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - T J Iwashyna
- Centre for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| | - A H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Shaw
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - T Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.,Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
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Chen HH, Chen HM, Chen YM, Chen YH, Lin CH, Chao WC. Impact of systemic lupus erythematosus on the 5-year survival of critically ill septic patients. Arthritis Res Ther 2021; 23:264. [PMID: 34674749 PMCID: PMC8528659 DOI: 10.1186/s13075-021-02649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Infectious disease is an increasing threat to patients with systemic lupus erythematosus (SLE); however, the long-term outcome in critically ill septic patients with SLE remains unclear, and we aimed to address the impact of SLE on 5-year survival in critically ill septic patients. Methods We used the 2003–2017 nationwide data with 825,556 patients with sepsis in Taiwan. We identified lupus cases with sepsis that required admission to the intensive care unit and mechanical ventilation and selected controls matched (1:4) for age, sex, and index-year. Conditional logistic regression analysis was used to determine risk factors for mortality risk and shown as odds ratios (HRs) with 95% confidence intervals (CIs). Results A total of 513 SLE-sepsis patients and 2052 matched non-SLE septic individuals were enrolled. The mortality rate was higher in the SLE group (38.5 per 100,000 person-year) than that in the non-SLE group (13.7 per 100,000 person-year), with an IRR of 2.8 (95% CI, 2.5–3.2). We found that SLE was independently associated with a high mortality rate after adjusting relevant variables (HR 1.47, 95% CI 1.27–1.77). In addition to SLE, a higher age (HR 1.02, 95% CI 1.02–1.02), more comorbidities, and receiving prednisolone equivalent dose higher than 5 mg/day (HR 1.55, 95% CI 1.27–1.90), methotrexate (HR 2.19, 95% CI 1.61–2.99), and immunosuppressants (HR 1.45, 95% CI 1.22–1.74) were also independent risks for mortality. Conclusions We identified that SLE affects the long-term mortality in critically ill septic patients, and more studies are warranted for the underlying mechanism. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02649-x.
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Affiliation(s)
- Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,Big Data Center, Chung Hsing University, Taichung, Taiwan
| | - Hsian-Min Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Computer Science & Information Engineering, National United University, Miaoli, Taiwan.,Department of Biomedical Engineering, HungKuang University, Taichung, Taiwan.,Center for Quantitative Imaging in Medicine (CQUIM), Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Wen-Cheng Chao
- Big Data Center, Chung Hsing University, Taichung, Taiwan. .,Department of Critical Care Medicine, Taichung Veterans General Hospital, 40705 Taiwan Avenue, Xitun District, No. 1650, Section 4, Taichung, Taiwan. .,Department of Computer Science, Tunghai University, Taichung, Taiwan. .,Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan.
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Schioppo T, Argolini LM, Sciascia S, Pregnolato F, Tamborini F, Miraglia P, Roccatello D, Sinico RA, Caporali R, Moroni G, Gerosa M. Clinical and peculiar immunological manifestations of SARS-CoV-2 infection in systemic lupus erythematosus patients. Rheumatology (Oxford) 2021; 61:1928-1935. [PMID: 34352079 PMCID: PMC8385869 DOI: 10.1093/rheumatology/keab611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with systemic lupus erythematosus (SLE) remains unclear and data on clinical manifestations after infection are lacking. The aim of this multicentre study is to describe the effect of SARS-CoV-2 in SLE patients. Methods SLE patients referring to 4 Italian centres were monitored between February 2020 and March 2021. All patients with SARS-CoV-2 infection were included. Disease characteristics, treatment, disease activity, and SARS-CoV-2 related symptoms were recorded before and after the infection. Results Fifty-one (6.14%) SLE patients were included among 830 regularly followed-up. Nine (17.6%) had an asymptomatic infection. Five (9.8%), out of 42 (82.6%) symptomatic, developed interstitial pneumonia (no identified risk factor). The presence of SLE major organ involvement (particularly renal involvement) was associated with asymptomatic SARS-CoV-2 infection (p-value = 0.02). Chronic corticosteroid therapy was found to be associated with asymptomatic infection (p-value = 0.018). Three SLE flares (5.9%) were developed after SARS-CoV-2 infection: one of them was characterized by MPO-ANCA positive pauci-immune crescentic necrotizing glomerulonephritis and granulomatous pneumonia. Conclusions SARS-CoV-2 infection determined autoimmune flares in a small number of our patients. Our data seem to confirm that there was not an increased risk of SARS-CoV-2 in SLE. Patients with asymptomatic SARS-CoV-2 infections were those having major SLE organ involvement. This may be explained by the high doses of corticosteroids and immunosuppressive agents used for SLE treatment.
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Affiliation(s)
- Tommaso Schioppo
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, University of Milan, Milan, Italy.,Lupus Clinic, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | | | - Savino Sciascia
- CMID-Nephrology and Dialysis Unit (ERK-net member), Research Center of Immunopathology coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Pregnolato
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Francesco Tamborini
- Divisione di Nefrologia e Dialisi, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Paolo Miraglia
- CMID-Nephrology and Dialysis Unit (ERK-net member), Research Center of Immunopathology coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Dario Roccatello
- CMID-Nephrology and Dialysis Unit (ERK-net member), Research Center of Immunopathology coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Renato Alberto Sinico
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca and Renal Unit, ASST-Monza, Milano/Monza, Italy
| | - Roberto Caporali
- Lupus Clinic, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele-Milan, Italy, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano-Milan, Italy
| | - Maria Gerosa
- Lupus Clinic, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
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8
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Mageau A, Aldebert G, Van Gysel D, Papo T, Timsit JF, Sacre K. SARS-CoV-2 infection among inpatients with systemic lupus erythematosus in France: a nationwide epidemiological study. Ann Rheum Dis 2021; 80:1101-1102. [PMID: 33727216 DOI: 10.1136/annrheumdis-2021-220010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Arthur Mageau
- Médecine Interne, Hôpital Bichat, AP-HP, Paris, France
- Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, INSERM UMR 1149, CNRS ERL8252, Paris, France
- Infection, Antimicrobials, Modeling, Evolution (IAME), INSERM UMR 1137, Paris, France
- Faculté de Médecine site Bichat, Université de Paris, Paris, France
| | | | - Damien Van Gysel
- Faculté de Médecine site Bichat, Université de Paris, Paris, France
- Département d'Information Médicale, Hôpital Bichat, AP-HP, Paris, France
| | - Thomas Papo
- Médecine Interne, Hôpital Bichat, AP-HP, Paris, France
- Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, INSERM UMR 1149, CNRS ERL8252, Paris, France
- Faculté de Médecine site Bichat, Université de Paris, Paris, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modeling, Evolution (IAME), INSERM UMR 1137, Paris, France
- Faculté de Médecine site Bichat, Université de Paris, Paris, France
- Réanimation Médicale et Infectieuse, Hôpital Bichat, AP-HP, Paris, France
| | - Karim Sacre
- Médecine Interne, Hôpital Bichat, AP-HP, Paris, France
- Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, INSERM UMR 1149, CNRS ERL8252, Paris, France
- Faculté de Médecine site Bichat, Université de Paris, Paris, France
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Rim D, Kaye A, Choi C, Ahlawat S. Inpatient Outcomes of Acute Pancreatitis Among Patients With Systemic Lupus Erythematosus: A Nationwide Analysis. Cureus 2021; 13:e16349. [PMID: 34306896 PMCID: PMC8279928 DOI: 10.7759/cureus.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study explores the characteristics and outcomes, including inpatient mortality, length of stay, and pancreatitis complications in patients hospitalized with acute pancreatitis (AP) with coexisting systemic lupus erythematosus (SLE). Methods Patients hospitalized with AP from the National Inpatient Sample from 2014 were selected. Patient characteristics and outcomes of AP were compared between the groups with and without SLE. Age, sex, race, Elixhauser Comorbidity Index (ECI), and etiologies of pancreatitis were measured. The outcomes of interest were inpatient mortality, length of stay, and complications, including respiratory failure, acute renal failure, myocardial infarction, hypotensive shock, sepsis, stroke, and ileus. Chi-squared tests and independent t-tests were used to compare proportions and means, respectively. Multivariate logistic regression analysis was performed to determine if SLE is an independent predictor for the outcomes, adjusting for age, sex, race, ECI, and etiologies of pancreatitis. Results Among 434,280 AP patients identified in the study, 3,015 patients had SLE. Among patients hospitalized with AP, those with SLE were younger, more likely to be female, more likely to be non-White, had higher ECI, and stayed longer in the hospital. Patients without SLE were more likely to have a history of cholelithiasis, alcohol abuse, and hypertriglyceridemia. AP patients presenting with SLE were at higher risk for respiratory failure, acute renal failure, hypotensive shock, stroke, and sepsis. Higher inpatient mortality was also associated with coexisting SLE. Conclusions Patients admitted for AP with SLE have worse outcomes compared to those without SLE. Understanding the potential effects of SLE on AP and optimizing patient care in this population accordingly may improve the quality of care and outcomes.
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Affiliation(s)
- Daniel Rim
- Internal Medicine, Rutgers University, Newark, USA
| | | | | | - Sushil Ahlawat
- Gastroenterology and Hepatology, Rutgers University, Newark, USA
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The role of type 1 interferons in coagulation induced by gram-negative bacteria. Blood 2020; 135:1087-1100. [PMID: 32016282 DOI: 10.1182/blood.2019002282] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Bacterial infection not only stimulates innate immune responses but also activates coagulation cascades. Overactivation of the coagulation system in bacterial sepsis leads to disseminated intravascular coagulation (DIC), a life-threatening condition. However, the mechanisms by which bacterial infection activates the coagulation cascade are not fully understood. Here we show that type 1 interferons (IFNs), a widely expressed family of cytokines that orchestrate innate antiviral and antibacterial immunity, mediate bacterial infection-induced DIC by amplifying the release of high-mobility group box 1 (HMGB1) into the bloodstream. Inhibition of the expression of type 1 IFNs and disruption of their receptor IFN-α/βR or downstream effector (eg, HMGB1) uniformly decreased gram-negative bacteria-induced DIC. Mechanistically, extracellular HMGB1 markedly increased the procoagulant activity of tissue factor by promoting the externalization of phosphatidylserine to the outer cell surface, where phosphatidylserine assembles a complex of cofactor-proteases of the coagulation cascades. These findings not only provide novel insights into the link between innate immune responses and coagulation, but they also open a new avenue for developing novel therapeutic strategies to prevent DIC in sepsis.
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Suárez-Avellaneda A, Quintana JH, Aragón CC, Gallego LM, Gallego CN, Bolaños JD, A Guerra M, Ochoa ME, Granados M, Ruiz-Ordoñez I, Tobón GJ. Systemic lupus erythematosus in the intensive care unit: a systematic review. Lupus 2020; 29:1364-1376. [PMID: 32723062 DOI: 10.1177/0961203320941941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%-78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.
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Affiliation(s)
- Ana Suárez-Avellaneda
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional; Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | | | - Cristian C Aragón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional; Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | | | | | | | | | - Maria Elena Ochoa
- Unidad de Cuidados Intensivos, Fundación Valle del Lili, Cali, Colombia
| | - Marcela Granados
- Unidad de Cuidados Intensivos, Fundación Valle del Lili, Cali, Colombia
| | - Ingrid Ruiz-Ordoñez
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional; Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional; Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
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Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study. J Intensive Care 2020; 8:3. [PMID: 31921427 PMCID: PMC6945625 DOI: 10.1186/s40560-019-0424-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Sepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. However, there are no population-level data on the patterns of the demand for critical care services among hospitalized septic patients with SLE or the outcomes of those admitted to the ICU. Methods We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File, to identify SLE hospitalizations aged ≥ 18 years and the subgroups with sepsis and ICU admission during 2009–2014. The patterns of ICU admission among septic hospitalizations were examined. Logistic regression modeling was used to identify predictors of short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions with sepsis and to estimate the risk-adjusted short-term mortality among ICU admissions with and without sepsis. Results Among 94,338 SLE hospitalizations, 17,037 (18.1%) had sepsis and 9409 (55.2%) of the latter were admitted to the ICU. Sepsis accounted for 51.5% of the growth in volume of ICU admissions among SLE hospitalizations during the study period. Among ICU admissions with sepsis, 25.3% were aged ≥ 65 years, 88.6% were female, and 64.4% were non-white minorities. The odds of short-term mortality among septic ICU admissions were increased among those lacking health insurance (adjusted odds ratio 1.40 [95% confidence interval 1.07–1.84]), while being unaffected by gender and race/ethnicity, and remaining unchanged over the study period. On adjusted analyses among ICU admissions, the short-term mortality among those with and without sepsis was 13% (95% CI 12.6–13.3) and 2.7% (95% CI 2.6–2.8), respectively. Sepsis was associated with 63.6% of all short-term mortality events. Conclusions Sepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE.
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Mageau A, Timsit JF, Perrozziello A, Ruckly S, Dupuis C, Bouadma L, Papo T, Sacre K. The burden of chronic kidney disease in systemic lupus erythematosus: A nationwide epidemiologic study. Autoimmun Rev 2019; 18:733-737. [DOI: 10.1016/j.autrev.2019.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/02/2019] [Indexed: 11/29/2022]
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