Infection is a major cause of mortality in patients with systemic lupus erythematosus (SLE). Therefore, minimizing the risk of infection is an important clinical goal to improve the long-term prognosis of SLE patients. Treatment with ≥7.5 mg prednisolone (PSL) or equivalent has been reported to increase the risk of infections. However, it remains unclear whether <7.5 mg PSL or equivalent dose affects the risk of infection in SLE patients. This study evaluated the association between the occurrence of infection in patients with SLE and low-dose glucocorticoid (GC) usage, especially <7.5 mg PSL or equivalent, to explore the GC dose that could reduce infection occurrence. This prospective cohort study included patients from the Japanese multicenter registry of patients with SLE (defined as ≥4 American College of Rheumatology 1997 revised criteria) over 20 years of age. The PSL dose was categorized as PSL 0–2.5, 2.6–5.0, 5.1–7.5, and 7.6–15.0 mg. The primary outcome was infection requiring hospitalization. We conducted a multivariable analysis using time-dependent Cox regression analysis to assess the hazard ratio of infection occurrence compared with a dose of 0–2.5 mg PSL or equivalent in the other three PSL dose groups. Based on previous reports and clinical importance, the covariates selected were age, sex, and concurrent use of immunosuppressants with GC. In addition, two sensitivity analyses were conducted. The mean age of the 509 SLE patients was 46.7 years; 89.0% were female, and 77.2% used multiple immunosuppressants concomitantly. During the observation period, 52 infections requiring hospitalization occurred. The incidence of infection with a PSL dose of 5.0–7.5 mg was significantly higher than that in the PSL 0–2.5 mg group (adjusted hazard ratio: 6.80, 95% confidence interval: 2.17–21.27). The results of the two sensitivity analyses were similar. Our results suggested that the use of 5.0–7.5 mg PSL or equivalent could pose an infection risk in SLE patients. This finding indicates that PSL dose should be reduced to as low as possible in SLE patients to avoid infection.

中文翻译：

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系统性红斑狼疮患者低剂量糖皮质激素使用与感染发生的关联：一项前瞻性队列研究

感染是系统性红斑狼疮（SLE）患者死亡的主要原因。因此，最大限度地降低感染风险是改善 SLE 患者长期预后的重要临床目标。据报道，使用≥7.5 mg 泼尼松龙 (PSL) 或等效药物治疗会增加感染风险。然而，目前尚不清楚<7.5 mg PSL 或等效剂量是否会影响 SLE 患者的感染风险。本研究评估了 SLE 患者感染的发生与低剂量糖皮质激素 (GC) 使用之间的关联，特别是 <7.5 mg PSL 或等效剂量，以探索可减少感染发生的 GC 剂量。这项前瞻性队列研究包括来自日本多中心登记的 20 岁以上 SLE 患者（定义为 ≥4 美国风湿病学会 1997 年修订标准）。PSL 剂量分为 PSL 0–2.5、2.6–5.0、5.1–7.5 和 7.6–15.0 mg。主要结果是需要住院治疗的感染。我们使用时间依赖性 Cox 回归分析进行了多变量分析，以评估与其他三个 PSL 剂量组中 0-2.5 mg PSL 或等效剂量相比感染发生的风险比。根据之前的报告和临床重要性，选择的协变量是年龄、性别和同时使用免疫抑制剂与 GC。此外，还进行了两次敏感性分析。509 名 SLE 患者的平均年龄为 46.7 岁；89.0% 为女性，77 人。2% 同时使用多种免疫抑制剂。观察期间发生需要住院治疗的感染病例52例。PSL 剂量为 5.0-7.5 mg 的感染发生率显着高于 PSL 0-2.5 mg 组（调整后的风险比：6.80，95% 置信区间：2.17-21.27）。两种敏感性分析的结果相似。我们的结果表明，使用 5.0-7.5 mg PSL 或同等剂量可能会给 SLE 患者带来感染风险。这一发现表明，SLE 患者的 PSL 剂量应尽可能降低以避免感染。95% 置信区间：2.17–21.27）。两种敏感性分析的结果相似。我们的结果表明，使用 5.0-7.5 mg PSL 或同等剂量可能会给 SLE 患者带来感染风险。这一发现表明，SLE 患者的 PSL 剂量应尽可能降低以避免感染。95% 置信区间：2.17–21.27）。两种敏感性分析的结果相似。我们的结果表明，使用 5.0-7.5 mg PSL 或同等剂量可能会给 SLE 患者带来感染风险。这一发现表明，SLE 患者的 PSL 剂量应尽可能降低以避免感染。