P LIU1, H TAN1, H LI2, C LIM1, J CHOO1
1Department of Renal Medicine, Singapore General Hospital, Singapore, 2Division of Research, Singapore General Hospital, Singapore
Aim: We aimed to evaluate predictors of onset of infection in a multiethnic Asian population with lupus nephritis (LN).
Background: Infection remains a leading cause of mortality among patients with LN. However, studies evaluating risk factors for infections in this group of patients are limited.
Methods: This was a single-center retrospective study of patients with newly diagnosed biopsy-proven LN from 2006 to 2012. Baseline characteristics, biochemical data, histopathological class, pharmacotherapy and infections data were obtained till end stage renal failure (ESRF), death, last follow-up or the year 2015. Logistic regression was carried out to evaluate potential predictors of infection onset.
Results: Our cohort of 101 patients consisted of mainly Chinese (75.2%), females (78.2%), and a median age of 38 years (IQR 26–49). The main histopathological findings were class III/IV (69.3%), class V (12.9%) and mixed class III/IV+V (14.9%). Sixty-eight (67.3%) patients received mycophenolate mofetil, 18 (17.8%) received cyclophosphamide and 8 (7.9%) received rituximab as primary induction therapy. Thirty-four (33.7%) patients received additional pulsed methylprednisolone. The median time to infection onset amongst 46 patients who developed infections was 61.5 days (IQR 22.5-609.5). The 3-, 6- and 12-month infection onset rates were 24.8%, 26.8%, and 30.1%, respectively. Multivariate logistic regression showed baseline urine protein creatinine ratio (UPCR) (OR 1.171 (95% CI 1.028-1.352), p = 0.0233), Malay compared to Chinese ethnicity (OR 6.544 (95% CI 1.767-31.962), p = 0.0088) and use of Rituximab (OR 13.224 (95% CI 1.959-268.428), p = 0.0237) as predictors of infection onset.
Conclusions: Severity of baseline proteinuria, ethnicity as well as induction immunosuppressant regimen play a role in predicting onset of infection in LN patients.
Dr Liu Peiyun graduated with MBBS from the National University of Singapore in 2009 and obtained her Membership from the Royal College of Physicians (MRCP) (United Kingdom) and Masters in Internal Medicine (MMed (Int Med) Singapore) in 2012. She completed her Senior Residency Training at Singapore General Hospital and was conferred Specialist Accreditation in Renal Medicine by the Ministry of Health, Singapore in 2017. Dr Liu is a general nephrologist trained in various aspects of Nephrology including Chronic Kidney Disease, Glomerulonephritis, Dialysis, Intensive Care Nephrology and Transplantation.