Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011

Abstract

BackgroundSystemic lupus erythematosus (SLE or lupus) is an autoimmune multisystem disease. While a complete understanding of lupus’ origins, mechanisms, and progression is not yet available, a number of studies have demonstrated correlations between disease prevalence and severity, gender, and race. There have been few population based studies in the United StatesObjectivesTo assess temporal changes in demographics and hospital mortality of patients with lupus in Washington State from 2003 to 2011Study DesignThis study used data from the Healthcare Cost and Utilization Project (HCUP), a patient information database, and data from the Washington State census to study a group of patients in the state. Lupus hospitalizations were defined as any hospitalization with an ICD-9-CM diagnosis code for systemic lupus erythematosus. Regression analysis was used to assess the effect of calendar time on demographics and hospital outcomes.ResultsThere were a total of 18,905 patients in this study with a diagnostic code for lupus. The mean age of the group was 51.5 years (95% CI: 50.6-52.3) in 2003 and 51.3 years (95% CI: 50.6-52.0) in 2011. The population was 88.6% female. Blacks were 2.8 times more likely to have a lupus hospitalization than whites when compared to the Washington population. While hospital mortality decreased during this eight year period (3.12% in 2003 to 1.28% in 2011, p=0.001) hospital length of stay remained statistically unchanged at an average of 4.9 days during that eight year period. We found a significant decrease in annual hospital mortality over the study period [odds ratio(OR): 0.92 per year, 95% CI 0.88-0.96, P<0.001]. Hospital mortality was higher in males (2.6% male death to 1.8% female death)ConclusionsIn this large group of hospitalized lupus patients in Washington, hospital length of stay remained relatively stable over time but hospital mortality decreased by over 50% over the eight year study period.

Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study

“…Fig 1 presents a flow chart of the selection process. This study used a population-based cohort study design [ 28 ] and ICD-9-CM codes to define the status of SLE (ICD-9-CM code 710.0) [ 29 ], and incident respiratory failure (ICD-9-CM codes 518.81, 518.83, and 518.84). In Taiwan, patients with chronic inflammatory diseases, including those with SLE, can apply for a catastrophic illness certificate; in addition, patients with SLE who fulfill 4 or more diagnostic criteria based on the American College of Rheumatology criteria are eligible for this certificate [ 13 ].…”

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

“…We identified hospitalizations of patients aged ≥ 18 years between the years 2009 and 2014 with a diagnosis of SLE, based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 710.0 in the principal or secondary diagnosis fields. This code was validated in administrative data, with sensitivity of 79.3%, specificity of 90.2%, and with a positive predictive value of 95.9% [27], and was used in prior studies of SLE [28,29]. Hospitalizations with sepsis were identified by the presence of either (a) a combination of ICD-9-CM codes for infection and one or more organ dysfunctions, as described by Angus et al [30], or (b) "explicit" codes for severe sepsis (995.92) or septic shock (785.52).…”

Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring

“…Studies have shown that the disproportionate burden of lupus among AAs negatively affects quality of life 72–76 and coping ability. 77 Some have positioned elevated rates of SLE in AA women in the context of “immune cognition”.…”