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

Objective 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). Conclusion 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.