Examining Hospitalization, Mortality Trends Among Adult Patients With Systemic Lupus Erythematosus

The most common reasons for hospitalization and in-hospital mortality among adults with systemic lupus erythematosus (SLE) were found to be cardiovascular, rheumatologic, and infectious diseases, according to study results published ACR Open Rheumatology.

Study authors extracted data from the National Inpatient Sample database, which included in-patient information from hospitals around the United States. All hospitalizations in 2017 with a principal or secondary diagnosis of SLE were included in the study. The International Classification of Disease, Tenth Revision (ICD-10) was used to identify principal and secondary diagnoses. The most common reasons for hospitalization and in-hospital mortality were evaluated. Demographic and clinical characteristics were assessed across hospitalizations.

Data from 180,975 hospitalizations were included in analyses. The majority (88%) of hospitalized patients were women. Mean age at hospitalization was 52 years.

The most common principal ICD-10 diagnoses in SLE hospitalizations were cardiovascular (16%), rheumatologic (13%), infectious (11%), respiratory (10%), and gastrointestinal (10%). Study authors noted that SLE was the principal diagnosis in only 6% of hospitalizations.

A total of 3630 patients (2%) had in-hospital mortality (mean age, 61 years; mean length of stay, 8.3 days). Infectious (37%), cardiovascular (21%), and respiratory (13%) disease were the most common causes of in-hospital mortality. Sepsis was the most frequent condition associated with in-hospital mortality, accounting for 935 of the 3630 deaths, followed by acute respiratory failure with hypoxia occurring in 110 patients.

As a study limitation, study authors noted that the use of diagnostic codes — rather than medical record review — may have led to the underreporting of SLE and other conditions. In addition, no outpatient data were available, limiting the adjustment for pre-existing conditions.

Study authors concluded, “…[T]his analysis represents the only report to date to comprehensively categorize reasons for hospitalization and in-hospital mortality of patients with SLE on a national level in the United States.” They added that these findings may be useful for clinicians who treat patients with SLE.

Reference

Manadan AM, Kambhatla S, Gauto-Mariotti E, Okoli C, Block JA. Reasons for hospitalization and in-hospital mortality in adult systemic lupus erythematosus. ACR Open Rheumatol. Published online November 8, 2020. doi:10.1002/acr2.11195