Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: A retrospective case-control study

Abstract

BackgroundPolymyositis and dermatomyositis (PM/DM) are systemic autoimmune diseases with multiple organ involvements that manifest as muscular and cutaneous disorders, interstitial lung disease (ILD) and malignancies. However, information concerning the outcomes and associated factors for PM/DM patients who are hospitalized is limited.MethodsWe retrospectively reviewed the medical charts of PM/DM patients admitted to a Chinese tertiary referral hospital (Peking Union Medical College Hospital, PUMCH) from 2008 to 2014. The deceased group included 63 patients who had “deceased discharge” status or were confirmed to have died within two weeks of hospital discharge. The demographic data, clinical manifestations, and direct causes of death were analyzed retrospectively. Medical records for 126 age- and sex-matched PM/DM patients were selected as controls from 982 inpatients successively admitted to the same center during the same period. In addition to the comparison of clinical manifestations between the two groups, binary logistic regression was conducted to explore the risk factors related to PM/DM mortality.ResultsOver the past 6 years at PUMCH, the in-hospital mortality rate of PM/DM patients was 4.58%. The male gender and the elder patients had a high risk of death (P = 0.031 and P = 0.001 respectively). The three most frequent causes of death for PM/DM patients were pulmonary infection (35%), ILD exacerbation (21%) or both conditions (25%). Pulmonary infection (P<0.001, OR = 5.63, 95% CI, 2.37–13.36), pneumomediastinum (P = 0.041, OR = 11.02, 95%CI, 1.10–110.54), Gottron’s papules (P = 0.010, OR = 3.24, 95%CI, 1.32–7.97), and elevated erythrocyte sedimentation rate (ESR) (P = 0.005, OR = 9.9, 95%CI 2.0–49.0) were independent risk factors for in-hospital mortality of PM/DM patients.ConclusionPM/DM patients continue to display high in-hospital mortality. Pulmonary infection is the strongest predictor of poor prognosis in PM/DM patients, followed by pneumomediastinum, Gottron’s papules, and elevated ESR.

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

“…In the following intragroup analysis, bacterial infection was found to be associated with unfavorable short-term outcome in DM, PM, or CADM patients complicated with AE-ILD. Similar linkage between infection and short-term outcome was seen in IIM patients (3,4). And opportunistic infection was as well-recognized as a major cause of mortality in patients with IIM-related ILD (48).…”

“…In published studies, the 10-year survival rate for patients with DM, PM, or CADM ranged from 51 to 91% (3). An ∼4.5% in-hospital mortality rate was seen in two retrospective studies (3,4).…”

The roles of neutrophil serine proteinases in idiopathic inflammatory myopathies

“…It has been reported that the serum LDH level has significant correlation with the degree of muscle weakness, muscle destruction, and the degree of muscle inflammation [ 35 ], and that the levels of LDH tend to indicate disease activity [ 27 ]. Serum levels of ESR and CRP are risk factors of interstitial lung disease (ILD) in DM/PM [ 36 – 39 ], elevated ESR is associated with increased mortality in patients with DM [ 37 , 40 ], and CRP has positive correlation with the global activity scores in DM [ 41 ]. So, to an extent, these parameters can reflect the activity or prognosis of DM/PM.…”

Biomarkers in Adult Dermatomyositis: Tools to Help the Diagnosis and Predict the Clinical Outcome

“…In the 63 patients of a retrospective Chinese cohort, elevated ESR was an independent risk factor for in-hospital mortality. The patients died of three main causes: infection, ILD, and association of ILD and infection [113]. Go et al [114] reported in a retrospective cohort that DM patients with baseline ESR ≥ 30 mm/h had significantly higher mortality, mainly related to respiratory failure.…”