Objective. Systemic lupus erythematosus (SLE) is an autoimmune disease with an increased risk of hospitalization. Multiple studies have reported SLE flare, infection, and cardiovascular (CV) events as the most common reasons for hospitalization. The aim of this study was to use a large US population-based database to comprehensively analyze all indications for adult SLE hospitalization and reasons for in-hospital mortality. Methods. We conducted a retrospective study of SLE hospitalizations in 2017 from the National Inpatient Sample database. The "reason for hospitalization" and "reason for in-hospital mortality" in patients with SLE were divided into 19 categories based on their principal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis. Results. A total of 180 975 hospitalizations carried either a principal or secondary ICD-10 code for SLE. The leading reasons for hospitalization were CV (16%), rheumatologic (13%), infectious (11%), respiratory (10%), and gastrointestinal (10%). SLE itself was the principal diagnosis in only 6% of the hospitalizations. In-hospital death occurred in 1 of every 50 SLE hospitalizations. Infectious (37%) and CV diagnoses (21%) were the most common reasons for in-hospital death, with sepsis being the most frequent reason for death. Conclusion. This analysis represents the only report to date that comprehensively categorizes the reasons for hospitalization and reasons for in-hospital mortality of patients with SLE on a US national level. SLE itself was the principal diagnosis for only a small percentage of hospitalizations. CV diagnoses were the most common reason for hospitalization. In-hospital death occurred in 1 of every 50 SLE hospitalizations. Infectious and CV diagnoses were the most common reason for in-hospital death. MATERIALS AND METHODS Data source. We conducted a retrospective study of adult SLE hospitalizations in 2017 in acute care hospitals across the United States from the National Inpatient Sample (NIS) database. An overview of the NIS database is available online at https:// www.hcup-us.ahrq.gov. The NIS was created and is maintained by the Agency for Healthcare Research and Quality and is the largest publicly available all-payer inpatient database in the United States. It was designed as a stratified probability sample to be representative of all nonfederal acute care hospitals nationwide. Hospitals are stratified according to ownership/ control, bed size, teaching status, urban/rural location, and geographic region. A 20% probability sample of all hospitals within

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Objective Diffuse alveolar hemorrhage (DAH) is a severe pulmonary complication of numerous diseases, including rheumatic conditions. We have conducted an observational study using inpatient data from the National Inpatient Sample to study the relationship of DAH with rheumatic conditions along with their descriptive characteristics. Methods An observational study was conducted on hospitalizations in 2016-2018 with a principal diagnosis of DAH from the United States National Inpatient Sample database. A multivariate logistic regression analysis was performed to calculate adjusted odds ratios (OR adj ) for risk factors of DAH. Results A total of 5420 DAH hospitalizations were identified among 90 million hospitalizations. Mortality in this group was found to be 24.3%. Majority of patients admitted with DAH were white and male, with a mean age of 61.8 years and a mean LOS of 10.6 days. Multivariate analysis showed that multiple rheumatic diseases were associated with DAH, including antineutrophil cytoplasmic antibody-associated vasculitis (AAV) (OR adj 72.56) (95% C.I. 50.607-104.043), antiphospholipid antibody syndrome (APLS) (OR adj 6.51) (95% C.I. 3.734-11.366), eosinophilic granulomatosis with polyangiitis (EGPA) (OR adj 7.13) (95% C.I. 1.886-26.926), Goodpasture's (OR adj 30.58) (95% C.I. 16.360-57.176), rheumatoid arthritis (RA) (OR adj 1.60) (95% C.I. 1.158-2.212), sarcoidosis (OR adj 3.99) (95% C.I. 2.300-6.926), and systemic lupus (SLE) (OR adj 5.82) (95% C.I. 3.993-8.481). Conclusion Although DAH is a relatively rare entity, it carries a very high mortality. Multiple rheumatic diseases were associated with DAH hospitalizations including AAV, APLS, EGPA, Goodpasture's, RA, sarcoidosis, and SLE. Key points • It is known that DAH carries a high morbidity and mortality based on prior literature. However, large datasets on the association of rheumatic diseases with DAH are lacking • This study identifies the descriptive characteristics of patients admitted to the hospital with DAH • This study also identifies the strength of association of rheumatic diseases with DAH

ObjectivePosterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome. There are many reports of PRES occurring in the setting of rheumatic diseases. However, it remains uncertain whether rheumatic diseases are truly a risk factor for PRES, as the literature consists of case reports and small clinical series. Here, we evaluated the relationship between PRES and the rheumatic diseases, using a large population-based data set as the reference.MethodsWe conducted a medical records review of hospitalizations in the United States during 2016 with a diagnosis of PRES. Hospitalizations were selected from the National Inpatient Sample. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to identify rheumatic diseases. A multivariate logistic regression analysis was used to calculate odds ratios (ORs) for the association of PRES and rheumatic diseases.ResultsThere were 3125 hospitalizations that had a principal billing diagnosis of PRES. Multivariate logistic regression revealed the multiple independent associations with PRES. The demographic and nonrheumatic associations included acute renal failure (OR, 1.52), chronic renal failure (OR, 12.1), female (OR, 2.28), hypertension (OR, 8.73), kidney transplant (OR, 1.97), and preeclampsia/eclampsia (OR, 11.45). Rheumatic associations with PRES included antineutrophil cytoplasmic antibody–associated vasculitis (OR, 9.31), psoriatic arthritis (OR, 4.61), systemic sclerosis (OR, 6.62), systemic lupus erythematosus (SLE) nephritis (OR, 7.53), and SLE without nephritis (OR, 2.38).ConclusionsThis analysis represents the largest sample to date to assess PRES hospitalizations. It confirms that several rheumatic diseases are associated with PRES, including antineutrophil cytoplasmic antibody–associated vasculitis, systemic sclerosis, SLE, and psoriatic arthritis. Acute and unexplained central nervous system symptoms in these patient populations should prompt consideration of PRES.