Risk Factors for Respiratory Failure in Patients Hospitalized With Systemic Sclerosis: An Analysis of the National Inpatient Sample

Abstract

BackgroundSystemic sclerosis (SSc) patients are at high risk for respiratory failure due to the progression of their disease. Investigating factors predictive of impending respiratory failure in this patient population can be used to improve hospital outcomes. Here, we investigate risk factors associated with developing respiratory failure in patients hospitalized with a diagnosis of SSc in the United States using a large, multi-year, populationbased dataset. MethodologyThis retrospective study was conducted on SSc hospitalizations from 2016 to 2019 with and without a principal diagnosis of respiratory failure from the United States National Inpatient Sample database. A multivariate logistic regression analysis was performed to calculate adjusted odds ratios (OR adj ) for respiratory failure. ResultsThere were 3,930 SSc hospitalizations with a principal diagnosis of respiratory failure and 94,910 SSc hospitalizations without a diagnosis of respiratory failure. Among SSc hospitalizations, multivariable analysis showed that the following were associated with a principal diagnosis of respiratory failure: Charlson comorbidity index (OR adj = 1.05), heart failure (OR adj = 1.81), interstitial lung disease (ILD) (OR adj = 3.62), pneumonia (OR adj = 3.40), pulmonary hypertension (OR adj = 3.59), and smoking (OR adj = 1.42). ConclusionsThis analysis represents the largest sample to date in assessing risk factors for respiratory failure among SSc inpatients. Charlson comorbidity index, heart failure, ILD, pulmonary hypertension, smoking, and pneumonia were associated with higher odds of inpatient respiratory failure. Patients with respiratory failure had higher in-hospital mortality compared to those without it. Outpatient optimization and inpatient recognition of these risk factors can lead to improved hospitalization outcomes for SSc patients.