Reasons for Hospitalization and In‐Hospital Mortality in Adult Systemic Lupus Erythematosus

Manadan, Augustine; Kambhatla, Soumyasri; Gauto‐Mariotti, Estefania; Okoli, Chimuanya; Block, Joel A.

doi:10.1002/acr2.11195

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…Although several studies have determined that individuals with SLE experience higher mortality than the general population (1,2), less is known about the causes contributing to death. Similar to prior research (17,19,20), this study found CVD to be among the top causes of mortality among individuals with SLE. CVD risk in individuals with SLE is not fully explained by traditional risk factors (21).…”

Section: Discussionsupporting

confidence: 87%

“…Manadan et al used data from the National Inpatient Sample and found that infections accounted for 37% of deaths, followed by CVD (21%) (17). Among our population‐based study of individuals with SLE, CVD was listed as the underlying cause of death for 33% of individuals, followed by rheumatic disease (18%); infections represented only 2% of deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Record‐axis codes are a set of ICD codes that best describe the overall medical certification portion of the death certificate based on an algorithmic process (16). ICD‐10 codes for “underlying” and “any” cause of death were then categorized into groups based on organ system and disease according to a previous study examining in‐hospital mortality in adult SLE (17).…”

Section: Methodsmentioning

confidence: 99%

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Causes of Death Among Individuals With Systemic Lupus Erythematosus by Race and Ethnicity: A Population‐Based Study

Taylor

Anastasiou

et al. 2022

Arthritis Care & Research

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Objective Non‐White populations are at higher risk of developing systemic lupus erythematosus (SLE) and have more severe outcomes, including mortality. The present study was undertaken to examine how specific causes of death vary by race and ethnicity, including Asian and Hispanic individuals. Methods The California Lupus Surveillance Project included SLE cases identified among residents of San Francisco County, CA during January 1, 2007 to December 31, 2009. Cases were matched to the National Death Index over a 10‐year period. Logistic regression examined age‐adjusted differences in causes of death by race, ethnicity, and sex. Age‐standardized mortality ratios between individuals with SLE and the corresponding general population were calculated for the leading cause of death, and observed versus expected deaths were estimated. Results The study included 812 individuals of White (38%), Asian (36%), Black (20%), and mixed/other/unknown (5%) race; 15% identified as Hispanic. One hundred thirty‐five deaths were recorded, with a mean ± SD age at death of 62.2 ± 15.6 years. Cardiovascular disease (CVD) was the leading cause of death overall (33%), and across all racial and ethnic groups, followed by rheumatic disease (18%) and hematologic/oncologic conditions (18%). CVD as the underlying cause of death was 3.63 times higher among SLE cases than in the general population. CVD deaths for those with SLE were nearly 4 and 6 times higher for Asian and Hispanic individuals with SLE, respectively, compared to the general population. Conclusion Individuals with SLE experience a disproportionate burden of CVD mortality compared to the general population, which is magnified for Asian and Hispanic groups.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Causes of Death Among Individuals With Systemic Lupus Erythematosus by Race and Ethnicity: A Population‐Based Study

Taylor

Anastasiou

et al. 2022

Arthritis Care & Research

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“…In studies conducted on other rheumatic diseases, it has been seen in similarity to pSS patients that disease activation and infection were the main reasons for hospitalization. The most common causes of hospitalization in SLE patients are SLE flares and organ involvement, infection, cardiovascular system diseases, and pregnancy-related conditions [ 9 , 15 , 16 , 20 , 21 ], whereas those in SSc patients are SSc-related causes (PAH, ILD, digital ulcer, renal crisis), infection, and heart failure [ 17 , 18 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Indications and risk factors for hospitalization in patients with primary Sjögren syndrome: experience from a tertiary center in Turkey

et al. 2022

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Objective In this study, it was aimed to reveal the hospitalization reasons for patients diagnosed with primary Sjögren syndrome (pSS) and potentially associated factors in a tertiary health center. Method One hundred and sixty-three pSS patients who regularly attended their follow-ups between January 2010 and May 2021 were included in the study. These patients’ reasons for hospitalization, duration of hospitalization, and numbers of presenting to the hospital were recorded. The demographic, clinical and serological characteristics of the hospitalized and non-hospitalized patients were compared. Results Hospitalization occurred in 22.7% of the patients, and the total number of hospitalizations was 79. The hospitalization incidence density rate was 6.21 per 100 patient-years. The most frequently encountered reason for hospitalizations was pSS-related organ involvement (44.3%). Infections (17.7%), malignancy (16.5%), endocrine, and various other reasons were the other indications for hospitalization. While male sex ( p = 0.005), the presence of extra-glandular involvement ( p < 0.001), and interstitial lung disease ( p = 0.001) were more common in the hospitalized patients, anti-nuclear antibody positivity was less frequent ( p = 0.032). The usage rate of hydroxychloroquine ( p = 0.022) was lower in the hospitalized patients, whereas the use of glucocorticoids ( p < 0.001) and azathioprine ( p = 0.005) was more frequent. The multivariable analyses revealed a relationship between extra-glandular involvement (OR: 4.57 [1.05–19.84], p = 0.043), glucocorticoid use (OR: 3.23 [1.13–9.21], p = 0.028) and hospitalization. Conclusion pSS-related system involvement and infection accounted for the majority of hospitalizations of the pSS patients. The presence of extra-glandular involvement and glucocorticoid use were found to be associated with hospitalization. Key Points • pSS-related system involvement and infection accounted for the majority of hospitalizations of pSS patients. • The presence of extra-glandular involvement was found to be associated with hospitalization.

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“…Systemic lupus erythematosus (SLE) is a risk factor for cardiovascular disease (CVD), which has emerged as a leading cause of death in this population ( 1 , 2 , 3 , 4 , 5 , 6 ). CVD can lead to major adverse cardiac events (MACE) after surgery.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Major Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus

Bruera

Lei

Blau

et al. 2022

ACR Open Rheumatology

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Objectives Patients with systemic lupus erythematosus (SLE) have a high risk of cardiovascular disease that could potentially increase postoperative major adverse cardiac events (MACE). We determined the rate of MACE in patients with SLE undergoing noncardiac surgery using national claims‐based data. Methods This was a retrospective cohort study using Optum Clinformatics Data Mart from 2007 to 2020. We identified a cohort of patients with SLE who had undergone noncardiac surgeries using Current Procedural Terminology codes. We also identified two control cohorts without SLE, one with diabetes mellitus (DM) and one without DM. After matching cases and controls by age and sex, the odds of MACE were estimated using multivariable logistic regression models also including race and the Revised Cardiac Risk Index (RCRI) scores. We also examined use of preoperative cardiac testing. Results We identified 4750 patients with SLE, 496,381 DM controls, and 1,484,986 non‐DM controls. After matching, the odds ratio (OR) for MACE in patients with SLE versus non‐DM controls was 1.51 (95% confidence interval 1.09‐2.08), which decreased after adjustment for RCRI score (OR: 0.97, 95% confidence interval 0.7‐1.36). No significant differences were observed in the incidence of MACE between patients with SLE and DM controls (0.82 vs 1.04, P = 0.16). High‐risk patients with SLE (RCRI score of ≥3) were less likely to receive preoperative cardiac testing than non‐DM controls (42.7% vs 35.1%, P < 0.05). Conclusion Patients with SLE have an increased risk of postoperative MACE, which is driven by increased RCRI scores. Concerningly, high‐risk patients received less cardiac testing 2 months before surgery than non‐DM controls.

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Reasons for Hospitalization and In‐Hospital Mortality in Adult Systemic Lupus Erythematosus

Cited by 15 publications

References 21 publications

Causes of Death Among Individuals With Systemic Lupus Erythematosus by Race and Ethnicity: A Population‐Based Study

Causes of Death Among Individuals With Systemic Lupus Erythematosus by Race and Ethnicity: A Population‐Based Study

Indications and risk factors for hospitalization in patients with primary Sjögren syndrome: experience from a tertiary center in Turkey

Postoperative Major Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus

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