Abstract
Objective
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a heterogeneous group of conditions resulting in frequent hospitalizations and high in-hospital mortality (IHM). Our study aimed to use the National Inpatient Sample (NIS) to determine and categorize the main reasons for hospital admission and IHM in patients with AAV.
Methods
We performed a retrospective study of adult AAV hospitalizations in 2016, 2017, and 2018 in acute care hospitals across the USA conducted using the NIS database. We classified the main reasons for hospital admission and IHM into 19 different categories using the principal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis.
Results
A total of 41,155 hospitalizations had either a principal or secondary ICD-10 code for AAV (GPA or MPA). Rheumatologic and respiratory diagnoses were the most common reasons for hospitalization, while infectious and respiratory diagnoses were the most common reasons for IHM. Sepsis, unspecified organism A41.9, was the most common specific principal diagnosis for hospitalized and deceased AAV patients.
Conclusions
Our results show that the leading reasons for hospitalization and mortality for AAV patients were rheumatologic, respiratory, and infectious diagnoses. This data suggests that careful monitoring and management of infectious and pulmonary complications in AAV may improve hospital outcomes.
Key points • AAV is a heterogeneous group of conditions resulting in frequent hospitalizations and high IHM. In our study, AAV hospitalizations ended in IHM 4.5% of the time, substantially greater than non-ANCA patients. • The leading reasons for hospital admission for AAV patients were rheumatologic and respiratory diagnoses, but the main reason for IHM were infectious and respiratory diagnoses. • Sepsis was the most common principal diagnosis for hospitalized and deceased AAV patients. • Our results highlight the importance of close monitoring and timely management of infectious and respiratory complications to improve hospitalization outcomes. |
Similar content being viewed by others
Data availability
Data was obtained from the 2016 to 2018 National Inpatient Sample databases.
Code availability
Not applicable.
References
Yates M, Watts R (2017) ANCA-associated vasculitis. Clin Med (Lond) 17(1):60–64. https://doi.org/10.7861/clinmedicine
Singh JA (2021) Infection versus cardiovascular disease as leading causes of hospitalisations and associated mortality in vasculitis in the U.S.: a national study. ClinExp Rheumatol. 39 Suppl 129(2):56–61
Ungprasert P, Koster MJ, Cheungpasitporn W, Wijarnpreecha K, Thongprayoon C, Kroner PT (2020) Inpatient epidemiology and economic burden of granulomatosis with polyangiitis: a 10-year study of the national inpatient sample. Rheumatol (Oxford) 59(12):3685–3689. https://doi.org/10.1093/rheumatology/keaa069
Wallace ZS, Fu X, Harkness T, Stone JH, Zhang Y, Choi H (2020) All-cause and cause-specific mortality in ANCA-associated vasculitis: overall and according to ANCA type. Rheumatol (Oxford) 59(9):2308–2315. https://doi.org/10.1093/rheumatology/kez589
Luo Y, Jiang C, Arevalo Molina AB, Murray S, Anez GC, Salgado M, Xu J (2020) Thirty-day hospital readmissions for granulomatosis with polyangiitis in the United States: a nationwide analysis. J Clin Rheumatol 26(5):192–196. https://doi.org/10.1097/RHU.0000000000001045
Holguin F, Ramadan B, Gal AA, Roman J (2008) Prognostic factors for hospital mortality and ICU admission in patients with ANCA-related pulmonary vasculitis. Am J Med Sci 336(4):321–326. https://doi.org/10.1097/MAJ.0b013e31816805fa
Rathmann J, Jayne D, Segelmark M, Jönsson G, Mohammad AJ (2021) Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study. Rheumatol (Oxford) 60(6):2745–2754. https://doi.org/10.1093/rheumatology/keaa699
Singh JA, Cleveland JD (2020) Epidemiology, Time-trends and outcomes of serious infections in patients with vasculitis: a 19-year national study. Arthritis Care Res (Hoboken). https://doi.org/10.1002/acr.24348
Golenbiewski J, Eudy A, Clowse M, Allen N. Hospital admissions and mortality in patients with ANCA-associated vasculitis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/hospital-admissions-and-mortality-in-patients-with-anca-associated-vasculitis/. Accessed June 28, 2021.
Lai QY, Ma TT, Li ZY, Chang DY, Zhao MH, Chen M (2014) Predictors for mortality in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: a study of 398 Chinese patients. J Rheumatol 41(9):1849–1855. https://doi.org/10.3899/jrheum.131426
Lode HM, Schmidt-Ioanas M (2005) Vasculitis and infection: effects of immunosuppressive therapy. Clin Nephrol 64(6):475–479. https://doi.org/10.5414/cnp64475
Gómez-Puerta JA, Hernández-Rodríguez J, López-Soto A, Bosch X (2009) Antineutrophil cytoplasmic antibody-associated vasculitides and respiratory disease. Chest 136(4):1101–1111. https://doi.org/10.1378/chest.08-3043
Ter Maaten JC, Franssen CF, Gans RO, van Schijndel RJ, Hoorntje SJ (1996) Respiratory failure in ANCA-associated vasculitis. Chest 110(2):357–362. https://doi.org/10.1378/chest.110.2.357
Seo P, Stone JH (2004) The antineutrophil cytoplasmic antibody-associated vasculitides. Am J Med 117(1):39–50. https://doi.org/10.1016/j.amjmed.2004.02.030
Fauci AS, Haynes BF, Katz P, Wolff SM (1983) Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 98(1):76–85. https://doi.org/10.7326/0003-4819-98-1-76
Rahmattulla C, de Lind van Wijngaarden RA, Berden AE, Hauer HA, Floßmann O, Jayne DR, Gaskin G, Rasmussen N, Noël LH, Ferrario F, Waldherr R, Wolterbeek R, Göçeroğlu A, Pusey CD, Hagen EC, Bruijn JA, Bajema IM; European Vasculitis Study Group (EUVAS) (2015) Renal function and ear, nose, throat involvement in anti-neutrophil cytoplasmic antibody-associated vasculitis: prospective data from the European Vasculitis Society clinical trials. Rheumatol (Oxford). 54(5):899–907. https://doi.org/10.1093/rheumatology/keu357
Frausova D, Brejnikova M, Hruskova Z, Rihova Z, Tesar V (2008) Outcome of thirty patients with ANCA-associated renal vasculitis admitted to the intensive care unit. Ren Fail 30(9):890–895. https://doi.org/10.1080/08860220802353892
Schilder AM (2010) Wegener’s Granulomatosis vasculitis and granuloma. Autoimmun Rev 9(7):483–487. https://doi.org/10.1016/j.autrev.2010.02.006
Villiger PM, Guillevin L (2010) Microscopic polyangiitis: Clinical presentation. Autoimmun Rev 9(12):812–819. https://doi.org/10.1016/j.autrev.2010.07.009
Mukhtyar C, Flossmann O, Hellmich B, Bacon P, Cid M, Cohen-Tervaert JW, Gross WL, Guillevin L, Jayne D, Mahr A, Merkel PA, Raspe H, Scott D, Witter J, Yazici H, Luqmani RA; European Vasculitis Study Group (EUVAS) (2008) Outcomes from studies of antineutrophil cytoplasm antibody associated vasculitis: a systematic review by the European League Against Rheumatism systemic vasculitis task force. Ann Rheum Dis. 67(7):1004–10. https://doi.org/10.1136/ard.2007.071936
Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, Höglund P, Jayne D, Luqmani R, Mahr A, Mukhtyar C, Pusey C, Rasmussen N, Stegeman C, Walsh M, Westman K; European Vasculitis Study Group (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 70(3):488–94. https://doi.org/10.1136/ard.2010.137778
Rathi M, Pinto B, Dhooria A, Sagar V, Mittal T, Rajan R, Dhir V, Kumar S, Sharma K, Nada R, Singh S, Minz RW, Sharma A (2016) Impact of renal involvement on survival in ANCA-associated vasculitis. Int Urol Nephrol 48(9):1477–1482. https://doi.org/10.1007/s11255-016-1330-z
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Disclosures
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The manuscript has not been published elsewhere.
Rights and permissions
About this article
Cite this article
Rivera, M., Villafranca, A., Khamooshi, P. et al. Reasons for hospitalization and in-hospital mortality for anti-neutrophil cytoplasmic antibody vasculitides: analysis of the National Inpatient Sample. Clin Rheumatol 41, 159–166 (2022). https://doi.org/10.1007/s10067-021-05880-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-021-05880-8