Abstract
Systemic lupus erythematosus (SLE) is a multisystem disorder. While several studies have outlined risk factors for hospitalization and mortality in SLE; the frequency of hospitalizations from various causes has varied among studies and over the years. We aimed to assess the causes of SLE hospitalizations and inpatient mortality compared to those without SLE in the United States in a recent year (2016) using a large national inpatient database. We used National Inpatient Sample (NIS) to identify hospitalizations with SLE using the ICD-10 code M32. Among hospitalizations with SLE as secondary diagnosis, we used ICD-10 codes to assess the primary diagnoses associated with hospitalizations and mortality. Our study included 174,105 SLE hospitalizations matched to controls (similar age, sex, and NIS stratum) in the year 2016. Mean age of hospitalization with SLE was 51.82 years, and 89% of hospitalized SLE patients were females. Mean length of stay, cost and mortality for SLE were 5.6 ± 7.2 days, US $ 14,450 and 1.96%, respectively. SLE was the primary diagnosis in 10,185 (5.85%) of all SLE related hospitalizations. Among SLE hospitalizations, infection was the most common primary diagnosis (15.80%) followed by cardiac and renal manifestations (7.03% and 4.91% respectively). Infection was the leading cause of mortality (38.18%) followed by cardiac manifestations (12.04%). Infections and cardiac involvement were the leading causes of hospitalizations and in-hospital mortality in SLE. Whether this is related to the disease itself, its associated comorbidities or immunosuppressive agents would require further studies.
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References
Jallouli M, Hriz H, Cherif Y et al (2014) Causes and outcome of hospitalisations in Tunisian patients with systemic lupus erythematosus. Lupus Sci Med. https://doi.org/10.1136/lupus-2014-000017
Lee JW, Park DJ, Kang JH et al (2016) The rate of and risk factors for frequent hospitalization in systemic lupus erythematosus: results from the Korean lupus network registry. Lupus 25:1412–1419. https://doi.org/10.1177/0961203316640916
Lee J, Dhillon N, Pope J (2013) All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatol Oxf Engl 52:905–909. https://doi.org/10.1093/rheumatology/kes391
Edwards CJ, Lian TY, Badsha H et al (2003) Hospitalization of individuals with systemic lupus erythematosus: characteristics and predictors of outcome. Lupus 12:672–676. https://doi.org/10.1191/0961203303lu452oa
Krishnan E (2006) Hospitalization and mortality of patients with systemic lupus erythematosus. J Rheumatol 33:1770–1774
Busch RW, Kay SD, Voss A (2018) Hospitalizations among Danish SLE patients: a prospective study on incidence, causes of admission and risk factors in a population-based cohort. Lupus 27:165–171. https://doi.org/10.1177/0961203317734919
HCUP Databases. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 31 Dec 2017
Hermansen M-L, Lindhardsen J, Torp-Pedersen C et al (2017) The risk of cardiovascular morbidity and cardiovascular mortality in systemic lupus erythematosus and lupus nephritis: a Danish nationwide population-based cohort study. Rheumatology 56:709–715. https://doi.org/10.1093/rheumatology/kew475
(2018) IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. https://www.ibm.com/support/pages/how-cite-ibm-spss-statistics-or-earlier-versions-spss. Accessed 3 Nov 2019
Alasmari A, Alsabaani A (2018) Causes and outcomes of hospitalization among systemic lupus erythematosus patients in Aseer Central Hospital, Saudi Arabia: a retrospective study. Egypt J Hosp Med 71:2358–2364
Teh CL, Chan GYL, Lee J (2008) Systemic lupus erythematosus in a tertiary, east Malaysian hospital: admission, readmission and death. Int J Rheum Dis 11:24–29. https://doi.org/10.1111/j.1756-185X.2008.00325.x
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RD—conception and design, drafting of the manuscript, revision. RKP—drafting of the manuscript. DRP—statistical analysis, revision. OO—statistical analysis. PP—edit and review. PK—conception and design, critical review. All authors have: given final approval of the version to be published; and agreed to be accountable for all aspects of the work.
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NIS database is a publicly available national database containing de-identified discharge data. An institutional review board approval was not required for the study as no personally identifiable information was used. The NIS database raw files were purchased through online HCUP (health care cost and utilization project) distributor, which were analyzed for this study.
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Dhital, R., Pandey, R.K., Poudel, D.R. et al. All-cause hospitalizations and mortality in systemic lupus erythematosus in the US: results from a national inpatient database. Rheumatol Int 40, 393–397 (2020). https://doi.org/10.1007/s00296-019-04484-5
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DOI: https://doi.org/10.1007/s00296-019-04484-5