Clinical Rheumatology

, Volume 37, Issue 8, pp 2081–2086 | Cite as

Severe infections in systemic lupus erythematosus: disease pattern and predictors of infection-related mortality

  • C. L. TehEmail author
  • S. A. Wan
  • G. R. Ling
Original Article


Infection is a major cause of morbidity and mortality among patients with systemic lupus erythematosus (SLE). To describe the pattern of serious infections in patients with SLE and to identify the predictors of infection-related mortality among SLE patients with serious infections, we prospectively studied all SLE patients who were hospitalized with infections in Sarawak General Hospital during 2011–2015. Demographic data, clinical features, and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of infection-related mortality. There were a total of 125 patients with 187 episodes of serious infections. Our patients were of multiethnic origins with female predominance (89.6%). Their mean age was 33.4 ± 14.2 years. The patients had a mean disease duration of 66.8 ± 74.0 months. The most common site of infection was pulmonary (37.9%), followed by septicemia (22.5%). Gram-negative organisms (38.2%) were the predominant isolates within the cohort. There were 21 deaths (11.2%) during the study period. Independent predictors of infection-related mortality among our cohort of SLE patients were flare of SLE (HR 3.98, CI 1.30–12.21) and the presence of bacteremia (HR 2.54, CI 0.98–6.59). Hydroxychloroquine was protective of mortality from serious infections (HR 9.26, CI 3.40–25.64). Pneumonia and Gram-negative organisms were the predominant pattern of infection in our SLE cohort. The presence of flare of SLE and bacteremia were independent prognostic predictors of infection-related mortality, whereas hydroxychloroquine was protective of infection-related mortality among SLE patients with serious infections.


Infection Mortality Systemic lupus erythematosus 



We would like to acknowledge the support of the Ministry of Health, Malaysia, for the technical support of the study.

Authors’ contributions

All authors were in involved in conception or design, or analysis and interpretation of data, or both. All authors approved the final version of the manuscript.

Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Jalan HospitalKuchingMalaysia
  2. 2.Rheumatology Unit, Department of Medicine, Sibu HospitalSibuMalaysia

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