SLE Diagnosed During Hospitalization Associated With Higher Disease Activity, Damage, and Death

Individuals with systemic lupus erythematosus (SLE) diagnosed during hospitalization (SLE) have worse outcomes, including higher baseline disease activity, more damage, and greater mortality, than those diagnosed on an outpatient basis, according to study results published in Revista Colombiana de Reumatologia.

A retrospective analysis was conducted to analyze the outcomes of patients with SLE diagnosed during hospitalization vs outpatient basis.

Two groups of patients were included in the study: those with SLE diagnosed during hospitalization and those with SLE diagnosed on an outpatient basis. Researchers collected demographic data from participants, including date of first SLE symptom and time between first symptom and diagnosis. The Lupus Disease Activity Index (SLEDAI) was used to calculate disease activity at the time of diagnosis.

During the 2-year follow-up period (or until death/loss to follow-up), the researchers assessed mortality and cumulative damage, according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index.

A general analysis was performed using descriptive statistics and the student’s t-test was employed to compare means. Kaplan-Meier curves, the log-rank test, and Cox proportional hazards were used to assess survival between the 2 groups.

A total of 123 patients with SLE (87% women; mean age, 34±12 years) who were diagnosed with SLE between 1997 and 2017 were include in the study; 45 (37%) of these participants were diagnosed with SLE during hospitalization.  

The hospitalized vs outpatient group had a significantly shorter time between symptom onset and diagnosis (144 vs 287 days; P =.04). The mean SLEDAI score at the time of diagnosis was 10±5 and 8.0±4 for the hospitalized and outpatient groups, respectively (P =.004). Within 6 months of diagnosis, those who were diagnosed during hospitalization vs on an outpatient basis received a significantly higher average cumulative glucocorticoid dose (6493±3404 mg vs 3563±2985 mg; P <.001) and had a higher rate of immunosuppressant use (62% vs 26%; P <.001).

Within a year of diagnosis, lupus nephritis 3 or 4 was found in the kidney biopsies of 31% and 12% of the hospitalized vs outpatient groups, respectively (P =.003). Within 2 years of diagnosis, participants diagnosed with SLE during hospitalization vs on an outpatient basis had a significantly higher mortality (13% vs 1.3%; P =.02), as well as higher damage, as determined by the SLICC/ACR Damage Index (P =.04).

Study limitations included the retrospective design, the single center at which many visitors did not have medical coverage, the inability to include many participants in follow-up due to diagnosis in other centers, and the significantly higher use of hydroxychloroquine among ambulatory participants.

The study researchers concluded that “patients diagnosed with SLE during hospitalization appear to form a group with a worse prognosis and should have, during the initial stages of the disease, strict follow-up by the professionals in charge, with the aim of controlling the activity of the disease, and implement all necessary measures to minimize the damage.”

Reference

Portaa S, Hassana R, Aquino V, et al. Systemic lupus erythematosus diagnosed during hospitalization: greater baseline disease activity, short-term damage, and death. Rev Colomb de Reumatol. Published online March 22, 2022. doi:10.1016/j.rcreue.2022.03.002