Autoimmunity reviews · 2026
Prevalence and clinical correlates of infection in idiopathic inflammatory myopathies: A systematic review and meta-analysis of 14,548 patients.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Yuan Gaodi, Xie Xiufang, Tang Min, Zheng Xiaoli, Luo Xiongyan, Xiong Anji
Аннотация
OBJECTIVE: Infection is an important cause of mortality in patients with idiopathic inflammatory myopathies (IIMs), yet its characteristics and associated risk factors remain inadequately assessed. This study aims to identify and provide clear effect sizes for infection risk factors in IIMs.
METHODS: In this systematic review and meta-analysis (PROSPERO CRD420251124359), we searched PubMed, Embase, and the Cochrane Library from inception to November 2025. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled prevalence and odds ratios (ORs) with 95% CIs were calculated using a random-effects model. For each clinical correlate, we prioritized the extraction of the most adjusted estimates; where unavailable, unadjusted ORs or data from 2 × 2 tables were utilized. For continuous variables, standardized mean differences (SMDs) were computed to ensure comparability across different laboratory standards. Heterogeneity was assessed using the I2 statistic. Subgroup analyses were conducted for anti-MDA5 positive dermatomyositis and Pneumocystis jirovecii pneumonia (PJP).
RESULTS: From 10,650 identified articles, 31 studies involving 14,548 patients with IIMs were included. The pooled infection prevalence was 24% (95% CI: 18-31%). Respiratory tract was the primary infection site; PJP, aspergillosis, and herpes zoster were the most prevalent pathogens. Meta-analysis identified multiple clinical correlates of infection risk. Key patient-related factors included older age, male sex, diabetes, and hypertension. Among clinical phenotypes, anti-MDA5 positivity (OR 3.41 [2.39-4.87]), rapidly progressive interstitial lung disease (OR 1.91 [1.35-2.71]), dermatomyositis (OR 1.77 [1.17-2.69]), skin ulcerations, and dysphonia were significant markers. Laboratory indicators, synthesized as standardized mean differences (SMD), confirmed that lower lymphocyte counts (SMD -0.29 [-0.48 to -0.10]), lower albumin (SMD -0.84 [-1.16 to -0.53]) and lower hemoglobin level were robustly associated with infection. Regarding treatment-related factors, significantly increased risks were observed for higher initial glucocorticoids dose (SMD 0.51 [0.08-0.93]), methylprednisolone pulse (OR 2.15 [1.28-3.62]), cyclophosphamide (OR 2.05 [1.40-3.02]), azathioprine, and intravenous immunoglobulin. Conversely, TMP-SMX prophylaxis (OR 0.21 [0.06-0.72]), anti-TIF1 - γ positivity (OR 0.52 [0.33-0.83]) and the polymyositis phenotype (OR 0.63 [0.44-0.91]) were associated with a reduced risk of infection.
CONCLUSION: Infection risk in patients with IIM is multifactorial, driven by a complex interplay of clinical phenotypes (notably anti-MDA5 positivity and RPILD), laboratory markers, and intensive immunosuppressive regimens. Our findings underscore the critical need for systematic risk stratification and support the broader implementation of targeted prophylaxis, particularly TMP/SMX, to mitigate morbidity and mortality in this vulnerable population.
METHODS: In this systematic review and meta-analysis (PROSPERO CRD420251124359), we searched PubMed, Embase, and the Cochrane Library from inception to November 2025. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled prevalence and odds ratios (ORs) with 95% CIs were calculated using a random-effects model. For each clinical correlate, we prioritized the extraction of the most adjusted estimates; where unavailable, unadjusted ORs or data from 2 × 2 tables were utilized. For continuous variables, standardized mean differences (SMDs) were computed to ensure comparability across different laboratory standards. Heterogeneity was assessed using the I2 statistic. Subgroup analyses were conducted for anti-MDA5 positive dermatomyositis and Pneumocystis jirovecii pneumonia (PJP).
RESULTS: From 10,650 identified articles, 31 studies involving 14,548 patients with IIMs were included. The pooled infection prevalence was 24% (95% CI: 18-31%). Respiratory tract was the primary infection site; PJP, aspergillosis, and herpes zoster were the most prevalent pathogens. Meta-analysis identified multiple clinical correlates of infection risk. Key patient-related factors included older age, male sex, diabetes, and hypertension. Among clinical phenotypes, anti-MDA5 positivity (OR 3.41 [2.39-4.87]), rapidly progressive interstitial lung disease (OR 1.91 [1.35-2.71]), dermatomyositis (OR 1.77 [1.17-2.69]), skin ulcerations, and dysphonia were significant markers. Laboratory indicators, synthesized as standardized mean differences (SMD), confirmed that lower lymphocyte counts (SMD -0.29 [-0.48 to -0.10]), lower albumin (SMD -0.84 [-1.16 to -0.53]) and lower hemoglobin level were robustly associated with infection. Regarding treatment-related factors, significantly increased risks were observed for higher initial glucocorticoids dose (SMD 0.51 [0.08-0.93]), methylprednisolone pulse (OR 2.15 [1.28-3.62]), cyclophosphamide (OR 2.05 [1.40-3.02]), azathioprine, and intravenous immunoglobulin. Conversely, TMP-SMX prophylaxis (OR 0.21 [0.06-0.72]), anti-TIF1 - γ positivity (OR 0.52 [0.33-0.83]) and the polymyositis phenotype (OR 0.63 [0.44-0.91]) were associated with a reduced risk of infection.
CONCLUSION: Infection risk in patients with IIM is multifactorial, driven by a complex interplay of clinical phenotypes (notably anti-MDA5 positivity and RPILD), laboratory markers, and intensive immunosuppressive regimens. Our findings underscore the critical need for systematic risk stratification and support the broader implementation of targeted prophylaxis, particularly TMP/SMX, to mitigate morbidity and mortality in this vulnerable population.