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In-hospital mortality and associated factors in patients with systemic lupus erythematosus: analysis over more than 11 years in a reference hospital center

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Abstract

Systemic lupus erythematosus (SLE) is a disease that affects the immune system, and it can lead to increased morbidity and mortality. The primary causes of mortality for individuals with SLE are disease activity, infections, drug toxicity, and other health conditions. The aim of this study is to estimate the mortality rate of patients with SLE who are hospitalized, describe the causes of death, and identify factors associated with mortality. The study was conducted at a referral hospital from 2009 to 2021, utilizing a nested case–control design. The records of patients with SLE who were hospitalized in the Department of Rheumatology were reviewed. Cases were identified as individuals who died during their hospitalization, while controls were those who were discharged alive during the same period. Elective hospitalizations were not included in the study. The primary causes of death were recorded, and demographic, clinical, laboratory, and immunological variables were analyzed as potential risk factors associated with in-hospital mortality. The study included 105 patients who died while hospitalized and 336 who were discharged alive. The estimated mortality rate was 10.93 deaths per 1000 hospital admissions per year. The leading causes of death were SLE activity (20%), infections (34.2%), or a combination of both (24.8%). Risk factors associated with in-hospital mortality were any infection (OR 2.5, CI 95% 1.2–5.2), nosocomial infections (OR 5.0, CI 95% 1.8–13.7), SLEDAI-2K > 2 (OR 2.0, CI 95% 1.02–3.8), lymphopenia (OR 2.1, CI 95% 1.01–4.6), anemia (OR 2.9, CI 95% 1.4–5.7), and thrombocytopenia (OR 3.3, CI 95% 1.7–6.4). Disease activity and infections, particularly nosocomial infections, are significant causes of mortality in hospitalized patients with SLE. Furthermore, hematological manifestations play a significant role in in-hospital mortality for these patients.

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Authors and Affiliations

  1. Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico

    Michelle Arrucha-Cozaya & Gabriela Martínez-Díaz

  2. Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Nuria Cecilia Zamora-Zúñiga, Dafhne Miranda-Hernández & Reyna Bustamante-González

  3. Facultad de Medicina, Universidad Veracruzana, Veracruz, Mexico

    Drusila Tovar-Rodríguez

  4. Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico

    Berenice López-Zamora

  5. Dirección de Educación e Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Mexico City, Mexico

    María Del Pilar Cruz-Domínguez

  6. Departamento de Medicina Interna, Hospital General Dr. Gaudencio Gonzalez Garza, Centro Médico Nacional La Raza, Mexico City, Mexico

    Abraham Edgar Gracia-Ramos

  7. División de Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Seris y Zaachila s/n, Col. La Raza, Alc. Azcapotzalco, CP 02990, Mexico City, Mexico

    Miguel Angel Saavedra

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  1. Michelle Arrucha-Cozaya
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Contributions

All authors meet the ICMJE criteria for authorship. MAS, NZZ, and MAC were involved in drafting or revising this article critically for important intellectual content. DMH, RBG, and AEGR made substantial contributions to the conception or design of the work. AEGR and MÁS drafted the work or revised it critically for important intellectual content. MAC, GMD, DTR, and BLZ contributed to the data collection and analysis. MPCD and MÁS revised the data analysis and the final manuscript. All authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Miguel Angel Saavedra.

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Congress abstract publications: This study was accepted as a plenary session in LI Mexican Congress of Rheumatology. Colegio Mexicano de Reumatología (2023) LI Congreso Mexicano de Reumatología. Reumatol Clin 19 (Supl Congr 1):1–14. https://www.reumatologiaclinica.org/es-vol-19-num-sc1-sumario-X1699258X23X00C10.

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Arrucha-Cozaya, M., Zamora-Zúñiga, N.C., Miranda-Hernández, D. et al. In-hospital mortality and associated factors in patients with systemic lupus erythematosus: analysis over more than 11 years in a reference hospital center. Rheumatol Int 43, 2221–2231 (2023). https://doi.org/10.1007/s00296-023-05469-1

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