Systemic Lupus Erythematosus Is Associated With a High Risk of Venous Thromboembolism in Hospitalized Patients Leading to Poor Outcomes and a Higher Cost: Results From Nationwide Inpatient Sample Database 2003‐2011

Kishore, Shweta; Jatwani, Shraddha; Malhotra, Bharat; Lirette, Seth T.; Mittal, Varun; Majithia, Vikas

doi:10.1002/acr2.1030

Cited by 13 publications

(20 citation statements)

References 29 publications

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“…To clarify morbidity and mortality of patients with SLE on a national level, we completed a comprehensive review of SLE hospitalizations using the most recent release of the NIS database. Prior studies of the NIS either queried for specific diagnoses of interest, examined only the most frequent diagnoses seen in patients with SLE, or limited the diagnoses reviewed (3,4,7,10‐12,15). For example, a recent analysis by Dhital et al (10) of the NIS 2016 reported on several organ/disease categories, but unfortunately many of these categories were incomplete.…”

Section: Discussionmentioning

confidence: 99%

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

Manadan

Kambhatla

Gauto‐Mariotti

et al. 2020

ACR Open Rheumatology

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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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Section: Discussionmentioning

confidence: 99%

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

Manadan

Kambhatla

Gauto‐Mariotti

et al. 2020

ACR Open Rheumatology

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“…Strikingly, SLE patients have been described to have a higher risk of thrombotic complications, which cannot be sufficiently explained by traditional risk factors ( 44 , 45 ). Those thrombotic complications include platelet hyperfunction ( 46 ), thrombotic microangiopathies (TMA) ( 47 ), venous thromboembolism (VTE) ( 48 ) and atherosclerosis ( 49 ). Moreover, it has been shown that C1q and other complement components are deposited on platelets of SLE patients and are associated with venous as well as arterial thrombotic events in those patients ( 50 – 52 ).…”

Section: Resultsmentioning

confidence: 99%

Complement C1q Enhances Primary Hemostasis

et al. 2020

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The cross-talk between the inflammatory complement system and hemostasis is becoming increasingly recognized. The interaction between complement C1q, initiation molecule of the classical pathway, and von Willebrand factor (vWF), initiator molecule of primary hemostasis, has been shown to induce platelet rolling and adhesion in vitro. As vWF disorders result in prolonged bleeding, a lack of C1q as binding partner for vWF might also lead to an impaired hemostasis. Therefore, this study aimed to investigate the in vivo relevance of C1q-dependent binding of vWF in hemostasis. For this purpose, we analyzed parameters of primary and secondary hemostasis and performed bleeding experiments in wild type (WT) and C1q-deficient (C1qa −/−) mice, with reconstitution experiments of C1q in the latter. Bleeding tendency was examined by quantification of bleeding time and blood loss. First, we found that complete blood counts and plasma vWF levels do not differ between C1qa −/− mice and WT mice. Moreover, platelet aggregation tests indicated that the platelets of both strains of mice are functional. Second, while the prothrombin time was comparable between both groups, the activated partial thromboplastin time was shorter in C1qa −/− mice. In contrast, tail bleeding times of C1qa −/− mice were prolonged accompanied by an increased blood loss. Upon reconstitution of C1qa −/− mice with C1q, parameters of increased bleeding could be reversed. In conclusion, our data indicate that C1q, a molecule of the first-line of immune defense, actively participates in primary hemostasis by promoting arrest of bleeding. This observation might be of relevance for the understanding of thromboembolic complications in inflammatory disorders, where excess of C1q deposition is observed.

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“…As a result, insights regarding the cost burden in the IMD population have been limited. Previously, cost studies of TE have focused on specific subtypes of TE, IMDs, or the cost burden of TEs among the general population or in populations without IMDs [7,[12][13][14]. For example, a retrospective study published in 2019 based on data from 2003 to 2011 found that hospitalization costs among patients with systemic lupus erythematosus who experienced VTEs were greater by $25,400 compared with those who did not experience VTEs [7].…”

Section: Discussionmentioning

confidence: 99%

“…TEs carry a significant economic burden [5]. Conservative estimates of the costs of incident venous TE (VTE) to the United States (US) healthcare system are approximately $7-10 billion each year [7]. TEs are also a strong predictor for unplanned readmissions in the US which can have a substantial economic impact on society [8].…”

Section: Introductionmentioning

confidence: 99%

The Economic Burden of Thromboembolic Events Among Patients with Immune-Mediated Diseases

Setyawan

Billmyer

et al. 2021

Adv Ther

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Introduction: Thromboembolic events (TEs) are associated with considerable costs. However, there is a paucity of evidence quantifying the economic burden associated with TEs among patients with immune-mediated diseases (IMDs). Methods: This retrospective cohort study used the IBM MarketScan Ò Commercial and Medicare Supplemental Claims databases (2014)(2015)(2016)(2017)(2018). Commercially insured adults with IMDs were classified into two cohorts based on diagnosis of TEs (deep vein thrombosis, pulmonary embolism, ischemic stroke, myocardial infarction). Patients in the TE cohort were matched on type of IMD, age, sex, and year of diagnosis to patients in the no TE cohort. In the TE cohort, the index date was the date of first TE following first IMD diagnosis. In the no TE cohort, the index date was assigned so the duration from first IMD diagnosis to index date matched the duration for the corresponding patient in the TE cohort. All-cause total healthcare costs were compared between cohorts in the 30-day and 1-year periods following the index date (inclusive). Unadjusted comparisons were conducted using Wilcoxon signed-rank tests. Adjusted results were estimated using generalized estimating equations with robust sandwich estimator. Results: Overall, 9681 matched patients were included in each cohort (mean age 61.1 years; 63.7% female). The TE cohort had higher proportions of comorbidities than the no TE cohort (Charlson Comorbidity Index [1.5 vs. 0.9]; p \ 0.0001). Adjusted all-cause total healthcare costs were significantly greater in the TE cohort versus no TE cohort in the 30-day and 1-year periods following the index date

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Systemic Lupus Erythematosus Is Associated With a High Risk of Venous Thromboembolism in Hospitalized Patients Leading to Poor Outcomes and a Higher Cost: Results From Nationwide Inpatient Sample Database 2003‐2011

Cited by 13 publications

References 29 publications

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

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

Complement C1q Enhances Primary Hemostasis

The Economic Burden of Thromboembolic Events Among Patients with Immune-Mediated Diseases

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