Association of dermatomyositis with systemic and opportunistic infections in the United States
Patients with dermatomyositis have multiple risk factors for serious and opportunistic infections, including immune dysregulation, long-term systemic corticosteroid treatment and comorbid health conditions. We sought to determine whether dermatomyositis is associated with increased odds and burden of systemic, opportunistic and antibiotic-resistant infections. We analyzed data from the Nationwide Inpatient Sample from 2002 to 2012, containing a cross-sectional representative 20% sample of all hospitalizations in the US. Overall, dermatomyositis was associated with serious infections in adults (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 2.19 [2.08–2.30]) and children (1.45 [1.20–1.76]). In particular, dermatomyositis was significantly associated with 32 of 48 and 15 of 48 infections examined in adults and children, respectively, including infections of skin, bone, joints, brain, heart, lungs, and gastrointestinal system, as well sepsis, antibiotic-resistant and opportunistic infections. Predictors of infections included non-white race/ethnicity, insurance status, history of long-term systemic corticosteroid usage, Cushing’s syndrome (likely secondary to corticosteroid usage), diabetes, and cancer. Serious infections were associated with significantly increased inpatient cost and death in dermatomyositis patients. In conclusion, dermatomyositis is associated with higher odds, costs and inpatient mortality from serious and opportunistic infections.
KeywordsDermatomyositis Hospitalization Inpatient Epidemiology Infection Opportunistic Cryptococcus Cytomegalovirus Hepatitis A virus Pneumocystis Long-term steroid use
International Classification of Disease 9th edition Clinical Modification
National Inpatient Sample
This publication was made possible with support from the Agency for Healthcare Research and Quality (AHRQ), grant number K12 HS023011, and the Dermatology Foundation.
Compliance with Ethical Standards
J. I. Silverberg had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: J. I. Silverberg. Acquisition of data: J. I. Silverberg, and Z. Ren. Analysis and interpretation of data: J. I. Silverberg, Z. Ren, A. Laumann. Drafting of the manuscript: J. I. Silverberg, Z. Ren, A. Laumann. Critical revision of the manuscript for important intellectual content: J. I. Silverberg, Z. Ren, A. Laumann. Statistical analysis: J. I. Silverberg, Z. Ren. Obtained funding: J. I. Silverberg. Administrative technical or material support: None. Study supervision: None.
Conflicts of interest
J. I. Silverberg, A. Laumann and Ziyou Ren have no relevant conflicts of interest to declare.
The study was approved by the institutional review board at Northwestern University.
- 1.(2015) Statistics USDoLBoL. CPI detailed report June 2015Google Scholar
- 2.Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate—a practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol 57:289-300. www.jstor.org/stable/2346101 (JSTOR)
- 12.Murray SG, Schmajuk G, Trupin L, Lawson E, Cascino M, Barton J, Margaretten M, Katz PP, Yelin EH, Yazdany J (2015) A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis. Arthritis Care Res 67:673–680. https://doi.org/10.1002/acr.22501 CrossRefGoogle Scholar
- 15.Silverberg JI, Norowitz KB, Kleiman E, Silverberg NB, Durkin HG, Joks R, Smith-Norowitz TA (2010) Association between varicella zoster virus infection and atopic dermatitis in early and late childhood: a case-control study. J Allergy Clin Immunol 126:300–305. https://doi.org/10.1016/j.jaci.2010.05.041 CrossRefPubMedGoogle Scholar