Background

Our aim was to characterize etiologic diagnoses obtained from bronchoalveolar lavage fluid (BALF) and blood specimens, and to identify risk factors for mortality in systemic lupus erythematosus (SLE) patients with pneumonia and respiratory failure.

Methods

We conducted a retrospective analysis of SLE patients with pneumonia and respiratory failure. Clinical characteristics, laboratory profiles, and microbiology in BALF and blood samples were evaluated. We performed univariable analyses to identify mortality risk factors.

Results

All 24 patients (F:M = 21:3, median age 46.5 years; disease duration 11 years) received mechanical ventilation (median duration: 11 days). Pathogens identified in BALF included Pneumocystis jiroveci (12 patients [50%]), cytomegalovirus (CMV, 7 patients [29.2%]), and bacteria (11 patients [45.8%]). Thirteen patients (54.2%) yielded pathogens in blood (CMV in 8 patients [33.3%] and Escherichia coli in 5 patients [20.8%]). Eight developed septic shock, and 9 died within 30 days. Univariable analysis identified thrombocytopenia (odds ratio [OR]: 8.0, 95% confidence interval [CI]: 1.23–52.25), bacteremia within 30 days before or after endotracheal intubation (OR: 8.0, 95% CI: 1.23–52.5), and P. jiroveci pneumonia (PJP, OR: 7.0, 95% CI: 1.04–46.95) as risk factors for 30-day mortality. Kaplan–Meier analysis confirmed an increased risk of 30-day mortality with thrombocytopenia and bacteremia.

Conclusion

There are high prevalence rates of PJP and CMV infections as evidenced by BALF analyses in SLE patients with pneumonia and respiratory failure. BALF analysis can facilitate rescue therapy per pathogen. Thrombocytopenia, bacteremia, and PJP in SLE patients can increase their 30-day mortality, so warrant early and aggressive treatments.

中文翻译：

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系统性红斑狼疮合并肺炎和呼吸衰竭患者支气管肺泡灌洗液分析及死亡风险

背景

我们的目的是描述从支气管肺泡灌洗液 (BALF) 和血液样本中获得的病因诊断，并确定伴有肺炎和呼吸衰竭的系统性红斑狼疮 (SLE) 患者死亡的危险因素。

方法

我们对伴有肺炎和呼吸衰竭的 SLE 患者进行了回顾性分析。评估了 BALF 和血液样本的临床特征、实验室概况和微生物学。我们进行了单变量分析以确定死亡风险因素。

结果

所有 24 名患者（F:M = 21:3，中位年龄 46.5 岁；病程 11 年）均接受了机械通气（中位持续时间：11 天）。在 BALF 中发现的病原体包括Pneumocystis jiroveci（12 名患者 [50%]）、巨细胞病毒（CMV，7 名患者 [29.2%]）和细菌（11 名患者 [45.8%]）。13 名患者 (54.2%) 在血液中产生病原体（8 名患者 [33.3%] 为 CMV， 5 名患者为大肠杆菌[20.8%]）。8 人出现感染性休克，9 人在 30 天内死亡。单变量分析确定了血小板减少症（优势比 [OR]：8.0，95% 置信区间 [CI]：1.23-52.25）、气管插管前后 30 天内的菌血症（OR：8.0，95% CI：1.23-52.5）和P. jiroveci肺炎 (PJP, OR: 7.0, 95% CI: 1.04–46.95) 作为 30 天死亡率的危险因素。Kaplan-Meier 分析证实血小板减少症和菌血症会增加 30 天死亡率的风险。

结论

PJP 和 CMV 感染的患病率很高，BALF 分析证实了肺炎和呼吸衰竭的 SLE 患者。BALF 分析可以促进每种病原体的抢救治疗。SLE 患者的血小板减少症、菌血症和 PJP 可增加其 30 天死亡率，因此需要早期积极治疗。