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Association of influenza infection with hospitalisation-related systemic lupus erythematosus flares: a time series analysis


1, 2, 3, 4, 5

 

  1. Division of Rheumatology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
  2. Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark.
  3. Division of Rheumatology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
  4. Division of Rheumatology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
  5. Division of Rheumatology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. jwas@catholic.ac.kr

CER13618
2021 Vol.39, N°5
PI 1056, PF 1062
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PMID: 33124567 [PubMed]

Received: 27/05/2020
Accepted : 14/09/2020
In Press: 27/10/2020
Published: 31/08/2021

Abstract

OBJECTIVES:
This study aimed to investigate whether the influenza annual outbreak in Korea is related to hospitalisation-related flares in systemic lupus erythematosus (SLE) patients.
METHODS:
The weekly frequency of hospitalisation-related SLE flares (2012-2015) was collected from the Korean National Health Insurance claim database. The weekly laboratory-confirmed detection rate of influenza infection was obtained from the Korea Centers for Disease Control and Prevention database. A generalised linear model was used to examine the relative risks (RRs) of hospitalisation-related SLE flares associated with influenza infection, after adjusting for time trends and meteorological data.
RESULTS:
A total of 2,223 hospitalisation-related SLE flares were analysed. An interquartile range (24.5%) increase in influenza infection was associated with a 14.0% increase in hospitalisation-related SLE flares (RR, 1.14; 95% confidence interval [CI]: 1.04–1.25; p=0.006). In addition, influenza infections at lag 0–1 (over 2 weeks including concurrent and 1 previous week) and lag 0–2 (over 3 weeks including concurrent and 2 previous weeks) were associated with increase in hospitalisation-related SLE flares (RR, 1.14; 95% confidence interval [CI]: 1.03–1.26; p=0.014 and RR, 1.13; 95% CI: 1.02–1.26; p=0.023). Significant associations were especially observed in women (RR, 1.15; 95% CI: 1.15–1.16; p=0.006) and immunosuppressant (RR, 1.26; 95% CI: 1.26–1.27; p<0.001) or glucocorticoid recipients (RR, 1.17, 95% CI: 1.16–1.17; p=0.004).
CONCLUSIONS:
This study shows a significant association between seasonal influenza infection and flares in SLE patients, which suggests influenza can be a novel environmental risk factor for SLE flares.

Rheumatology Article

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