John H. Stroger Jr. Hospital of Cook County Chicago, IL, United States
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Saman Tanveer and Chun Pan, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
Background/Purpose: Immunosuppressive therapy is the cornerstone of management in patients with systemic lupus erythematosus (SLE). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology of fungal infections in this cohort.
Methods: We analyzed the National Inpatient Sample (NIS) 2016-2020 for all patients with discharge diagnosis of SLE & Fungal infections (Histoplasmosis, Pneumocystosis, Cryptococcosis, Aspergillosis, Blastomycosis, candidiasis, Coccidioidomycosis) as primary or secondary diagnosis via ICD-10 codes. Frequencies, demographics and trends were determined and compared between hospitalized patients with SLE and without SLE. A p-value of ≤0.05 was considered statistically significant.
Results: In hospitalized SLE patients, there was higher risk of developing fungal infections in male gender and in Hispanics & Asian populations. Steroid use, concomitant HIV infection and the presence of leukemias & lymphomas in hospitalized SLE patients were significant predictors of fungal infection (Figure 1). There were also differences in the incidence of different fungal infections based on geographical areas in the US, with Blastomycosis being more common in the Midwest. From 2016 to 2020, there was a decline in the incidence rate of hospitalization per 100,000 for non-SLE patients with fungal infections whereas this rate remained steady for the SLE cohort (Figure 2).
Conclusion: The frequency of hospitalized SLE patients with fungal infections has remained stable between 2016 to 2020 compared to non-SLE patients for which this rate has decreased. This difference could be explained by the use of immunosuppressive therapy in SLE patients. Further studies can be done to explain the increased risk of fungal infections in hospitalized SLE patients who are males, Hispanics and Asians.
Figure 1 - Various predictors of fungal infections in hospitalized SLE patients (CI: Confidence Interval)
Figure 2 - Decrease in incidence rate of hospitalization per 100,000 for non-SLE patients with fungal infections; incidence rate of hospitalization per 100,000 for SLE patients with fungal infections has remained stable
