Objective: The study aims to assess baseline immune factors that can predict the risk of severe infections in autoimmune rheumatic disease (ARD) patients, to aid in optimising immunosuppressive therapy. Methods: The prospective, observational study was carried out at a tertiary centre in India between December 2019 and March 2022, targeting adult patients with ARDs who required escalated immunosuppressive treatment. A comprehensive medical history, clinical examination, and baseline laboratory tests were conducted, including complete blood counts, inflammatory markers, immunoglobulin levels, immune cell counts, complement levels, and viral screening. Patients were followed for one year to track infections and hospitalisations. Descriptive statistics, ANOVA, chi-square tests, t-tests, and Fisher’s exact tests were employed for data analysis, with ordinary least squares (OLS) regression performed to identify significant factors predicting infection risk. Results: The study analysed 102 ARD patients over 13.1 months. Older age (OR: 1.050; CI: 1.003-1.100), low CD4 count (OR: 6.855; CI: 0.854-55.037), low CD4/CD8 ratio with (OR: 2.625; CI: 0.282-24.435), low IgG (OR: 4.500; CI: 0.251-80.565)/IgM (OR: 5.036; CI: 0.925-27.414), thrombocytopenia (OR: 3.865; CI: 1.148-13.012), high NLR (OR: 3.870; CI: 0.998-15.013), and positive anti-HBs (OR: 3.750; CI: 1.190-12.679) were linked to severe infections or death. Steroid use was significantly associated with severe outcomes, while other prior medications, including immunosuppressive therapy and biologics, showed no notable differences. Conclusion: CD4 counts, IgM levels, and the CD4/CD8 ratio, as well as platelet counts, are strong predictors of severe infections and mortality. Increased levels of inflammatory markers, such as ESR and NLR, also elevated the risk. Older age and steroid treatment further increase susceptibility. Patients with these characteristics should be closely monitored and given appropriate prevention strategies to reduce infection risks and related mortality.
J et al. (Mon,) studied this question.