Effect of systemic lupus erythematosus on the risk of incident respiratory failure: A national cohort study

Abstract

Purpose: We conducted a nationwide cohort study to investigate the relationship between systemic lupus erythematosus (SLE) and the risk of incident respiratory failure. Methods: From the National Health Insurance Research Database, we identified 11 533 patients newly diagnosed with SLE and 46 132 controls without SLE who were randomly selected through frequency-matching according to age, sex, and index year. Both cohorts were followed until the end of 2011 to measure the incidence of incident respiratory failure, which was compared between the 2 cohorts through a Cox proportional hazards regression analysis. Results: The adjusted hazard ratio (aHR) of incident respiratory failure was 5.80 (95% confidence interval [CI] = 5.15-6.52) for the SLE cohort after we adjusted for sex, age, and comorbidities. Both men (aHR = 3.44,95% CI = 2.67-4.43) and women (aHR = 6.79, 95% CI = 5.93-7.77) had a significantly higher rate of incident respiratory failure in the SLE cohort than in the non-SLE cohort. Both men and women aged <35 years (aHR = 31.2,95% CI = 21.6-45.2), 35-65 years; (aHR = 6.19, 95% CI = 5.09-7.54) and ≥65 years (aHR = 2.35, 95% CI = 1.92-2.87) had a higher risk of incident respiratory failure in the SLE cohort. Moreover, the risk of incident respiratory failure was higher in the SLE cohort than the non-SLE cohort, for subjects with (aHR = 2.65, 95% CI = 2.22-3.15) or without (aHR = 9.08, 95% CI = 7.72-10.7) pre-existing comorbidities. In the SLE cohort, subjects with >24 outpatient visits and hospitalizations per year had a higher incident respiratory failure risk (aHR = 21.7, 95% CI = 18.0-26.1) compared with the non-SLE cohort. Conclusion: Patients with SLE are associated with an increased risk of incident respiratory failure, regardless of their age, sex, and pre-existing comorbidities; especially medical services with higher frequency.