Association Between Traditional Chinese Medicine Use and Sepsis Risk and Glucocorticoid Exposure in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study

AIM: Sepsis greatly increases morbidity and mortality in patients with systemic lupus erythematosus (SLE). Conventional treatments, particularly glucocorticoids (GCs), raise infection risk. This retrospective cohort study aims to investigate the association of Traditional Chinese Medicine (TCM) use with sepsis incidence, mortality, and GC dependence in patients with SLE, based on data from the Chang Gung Research Database (CGRD).

METHODS: Patients in Taiwan with newly diagnosed SLE were enrolled from the CGRD between 2005 and 2020. They were stratified into groups based on TCM treatment post-diagnosis. Outcomes included sepsis incidence and the dose and duration of GC usage. Data were analyzed using Cox proportional hazard models and Kaplan-Meier analysis.

RESULTS: The study included 10 846 newly diagnosed patients with SLE, of whom 1801 received at least 28 days of TCM treatment, while 8302 did not. After propensity score matching, 5403 and 1801 individuals were included in the non-TCM and TCM groups, respectively, with no significant baseline differences in age, sex, biochemical profiles, and comorbidities between the groups. Integrative TCM usage was associated with a significantly lower risk of sepsis (adjusted hazard ratio [aHR]: 0.49; 95% confidence interval [CI]: 0.40-0.60, p < 0.001) and mortality rate (aHR 0.52, 95% CI 0.44-0.60, p < 0.001) over an 18-year period. Additionally, the TCM group had a significantly lower daily GC dose (1.74 vs. 2.47 units/day; p = 0.02).

CONCLUSION: TCM use was significantly associated with lower risks of sepsis and lower GC dosage in patients with SLE, suggesting its potential as an integrative therapy.