Background/Purpose: Neuromyelitis optica (NMO) is an autoimmune inflammatory disorder that can coexist with systemic lupus erythematous (SLE). Given the immunosuppressive nature of SLE, it is therefore crucial to assess if there is an increase in infections in hospitalized patients with NMO and SLE overlap, as this has not been well studied.  This study aims to explore acute cystitis, gastrointestinal infections, upper respiratory infections, pneumonia, skin infections and severe sepsis in SLE patients with NMO overlap.

Methods: National Inpatient Sample (NIS) database was used to sample individuals with SLE and NMO and baseline comorbidities and demographics were collected using ICD-10 codes. Patients were stratified into two groups consisting of patients with SLE alone and patients with SLE/NMO overlap. Multivariate Logistic Regression analysis was performed and a p-value of < 0.05 was considered significant.

Results: Of 105,930 SLE patients included in the study 153 had Neuromyelitis Optica. SLE/NMO overlap had a higher prevalence of acute cystitis and severe sepsis compared to SLE alone.  Patients with SLE/NMO overlap were 3 times more likely to develop acute cystitis during hospitalization (adjusted OR: 3.019  [2.795-3.260]; p< 0.001) compared to SLE patients alone.  Additionally, SLE/NMO overlap patients were 2 times more likely to develop severe sepsis during hospitalization (adjusted OR: 2.072 [1.362-4.473]; p=0.017) compared to SLE patients alone.

Conclusion: Coexisting systemic lupus erythematous and neuromyelitis optica was associated with increased risk of acute cystitis and severe sepsis.  We hypothesize that a high inflammatory state and significant immunosuppression contributed to this increased risk.  Larger studies may be needed to corroborate our findings.

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematous-and-neuromyelitis-optica-overlap-and-risk-of-infection-in-hospitalized-patients/