Causes and outcome of hospitalisations in Tunisian patients with systemic lupus erythematosus

Analysis of 5-year hospitalization data of patients with systemic lupus erythematosus: Damage is a risk factor for frequent and longer stays

OBJECTIVE

The annual hospitalization rate of patients with systemic lupus erythematosus (SLE) is approximately 10%, and hospitalizations are responsible for most of the healthcare expenses. Herein, we analyzed 5-year hospitalization data of SLE patients and determined factors leading to hospitalization.

METHODS

Clinical, laboratory, and hospitalization data of SLE patients admitted to our rheumatology clinic in 2015-2020 were retrieved from our SLE database and analyzed. SLICC SLE damage index (SDI) and disease activity at admission (SLEDAI-2K) were determined.

RESULTS

Among 161 hospitalized patients, 86% were females. Total rheumatologic hospitalization number was 298, and 38% of the patients were hospitalized more than once (1.85 ± 1.56). The mean hospitalization duration covering all stays for each patient was 25 ± 26.5 days. Active disease, infection, and damage-related complications were first three causes of hospitalization. Compared to patients hospitalized for active disease or damage, patients hospitalized for infection had a significantly higher number of readmissions (p < .05) and their total hospital stay was longer (p < .01).The frequency of patients with damage and the mean SDI score was significantly lower in the active disease group (68%, 1.93 ± 2.05) than hospitalizations for infection (90%, 2.68 ± 1.63) and damage-related causes (96%, 3.04 ± 1.65) (p < .05). The mean SDI score and duration (r = 0.551, p < .001) and the number of hospitalizations (r = 0.393, p < .001) were positively correlated. The mean disease activity scores of patients hospitalized for active disease, infection, and damage-related reasons were 11.03 ± 6.08, 3.21 ± 2.80, and 2.96 ± 3.32, respectively (p < .001). Renal active disease was the most common (44%), followed by hematological (34.8%), articular (21.7%), and mucocutaneous (21%) activity.Ten percent of the patients all of whom had damage were admitted to intensive care unit (ICU). Total hospitalization duration, mean SDI, antiphospholipid syndrome, lupus anticoagulant, thrombocytopenia, serositis, pulmonary hypertension, history of alveolar hemorrhage, and cardiac valve involvement were associated with ICU admission (p < .05 for all).

CONCLUSION

Disease activity, infections, and damage are the leading causes of hospitalization in SLE patients. Damage prolongs hospital stay and increases hospitalization rate and ICU need. Tight control of disease activity with rational use of immunosuppressive treatment is important to reduce damage and hospitalizations.

Adherence patterns to medications and their association with subsequent hospitalization in adult Egyptian patients with systemic lupus erythematosus

OBJECTIVE

The aim of this study was to evaluate the adherence pattern to medications and the influence of non-adherence on hospitalization rate among Egyptian patients who were diagnosed with systemic lupus erythematosus (SLE).

METHODS

This cross-sectional interview-based study was conducted in an Egyptian rheumatology outpatient clinic. Individuals with SLE who were prescribed oral medications were included in the study. The 19-item Compliance Questionnaire of Rheumatology (CQR) was employed to evaluate drug adherence. Patients were classified as non-adherent and adherent group based on their CQR score Sociodemographic variables, clinical and therapeutic data, and the frequency of outpatient visits and hospitalization were collected and compared between the two groups.

RESULTS

In total, there were 161 SLE patients who participated in the study with mean age 30.70 ± 9.62 years, 129 females and 32 males (F:M 5.4:1). Of them, 93 patients were assigned to the non-adherent group, whereas 68 patients were assigned to the adherent group. There was a statistically significant difference in terms of marital status (p = 0.009), employment (p = 0.032), and the frequency of physical activity (p = 0.045) between the two groups. The adherents had a higher rate of administration of antimalarials (88.2% vs 75.3%, p = 0.039). The frequency of recurrent fever was lower in adherents (23.5% vs 38.7%, p = 0.042), lymphadenopathy (11.8% vs 31.2%, p = 0.004), recurring oral ulcers (25% vs 50.5%, p = 0.001), and substantial hair loss (87.1% vs 98.5%, p = 0.009) in comparison to non-adherents. The number of yearly outpatient visits was considerably greater in adherents (p = 0.007), while the number of prior hospitalizations was higher in non-adherents (p < 0.001). Non-adherents believed that taking medicines disrupt patients' daily routine (p < 0.001) and were more afraid of the occurrence of an adverse drug reaction (p < 0.001).

CONCLUSIONS

Egyptian SLE patients have an alarmingly high percentage of medication non-adherence. There is a strong association between medication non-adherence and frequency of hospitalization and cumulative clinical manifestations.

Trends in all-cause hospitalizations for systemic lupus erythematosus in Mexico, 2000-2019

BACKGROUND

Hospitalizations due to systemic lupus erythematosus (SLE) incur substantial resource use. Hospitalization trends provide a key benchmark of the disease burden. However, there is little long-term data in Mexico. Therefore, we evaluated Mexican hospitalization trends for SLE during 2000-2019.

METHODS

Hospitalization trends of SLE were studied using data from 2000 to 2019 releases of the National Dynamic Cubes of the General Direction of Health Information, which provides data on hospitalization discharges in Mexico. Patients aged ≥15 years hospitalized during the study period with a principal discharge diagnosis of SLE (ICD-10 code M32) were included.

RESULTS

From 2000 to 2019, there were 17,081 hospitalizations for SLE, of which 87.6% were in females and 87% in subjects aged 15-44 years. From 2000 to 2019, the age-standardized hospitalization rate for patients with SLE increased from 0.38 per 100,000 persons to 0.65 per 100,000 persons with an average annual percentage change (APC) of 2.9% (95% CI 6.2-63.2). Although there was a significant uptrend from 2000 through 2011, there was a significant decline from 2011 to 2019 (APC: -4.8%, 95% CI -7.0% to -2.5%). Similar trends were identified in subjects aged 15-44 years and in both sexes. The length of stay and inpatient mortality decreased between 2000-2009 and 2010-2019.

CONCLUSIONS

Although there was a substantial increase in SLE hospitalizations in 2000-2019, in 2011-2019, a decreased trend was reported in younger patients and in females and males. The length of stay was also reduced.

First Diagnosis of Systemic Lupus Erythematosus in Hospitalized Patients: Clinical Phenotypes and Pitfalls for the Non-Specialist

BACKGROUND

Prompt recognition of systemic lupus erythematosus (SLE) in hospitalized patients presenting with severe disease is essential to initiate treatment. We sought to characterize the phenotype of hospitalized patients with new-onset SLE and estimate potential diagnostic delays.

METHODS

An observational study of 855 patients ("Attikon" SLE cohort). Clinical phenotype was categorized according to the leading manifestation that led to hospitalization. Disease features, time to diagnosis, classification criteria, and the SLE Risk Probability Index (SLERPI) were recorded for each patient.

RESULTS

There were 191 patients (22.3% of the total cohort) hospitalized due to manifestations eventually attributed to SLE. Main causes of admission were neuropsychiatric syndromes (21.4%), cytopenias (17.8%), nephritis (17.2%), and thrombotic events (16.2%). Although 79.5% of patients were diagnosed within 3 months from hospitalization, in 39 patients diagnosis was delayed, particularly in those with hematological manifestations. At hospitalization, a SLERPI >7 (indicating high probability for SLE) was found in 87.4% of patients. Patients missed by the SLERPI had fever, thrombotic or neuropsychiatric manifestations not included in the algorithm. Lowering the SLERPI threshold to 5 in patients with fever or thrombotic events increased the diagnostic rate from 88.8% to 97.9% in this subgroup, while inclusion of all neuropsychiatric events yielded no additional diagnostic value.

CONCLUSION

One in five patients with new-onset SLE manifest disease presentations required hospitalization. Although early diagnosis was achieved in the majority of cases, in approximately 20%, diagnosis was delayed. A lower SLERPI cut-off (≥5) in patients with fever or thrombosis could enhance early diagnosis.

Reasons for hospitalisation in patients with systemic lupus erythematosus in a university hospital in Buenos Aires

OBJECTIVE

To determine the reasons for hospitalisation in patients with systemic lupus erythematosus (SLE) admitted to the Hospital de Clínicas "José de San Martín" Buenos Aires, Argentina.

METHODS

We retrospectively analysed the clinical histories of SLE patients (SLICC 2012) during or prior to hospitalisation, from 1-2014 to 12-2017. Demographic data, reasons for hospitalisation, treatments, SLEDAI-2 K and comorbid conditions.

RESULTS

121 hospitalisations corresponding to 72 patients, 25 patients (34.7%) were hospitalised more than once. Females (83.3%), the median length of disease until admission was 5 years. There was more than one reason for hospitalisation in 32, a total of 164 reasons. The main reason was relapse of disease (52.4%). The most frequent manifestations were renal involvement, serositis and pulmonary involvement. Infections were the second reason for hospitalisation (26.8%); urinary tract, pneumonia and soft tissue. Cardiovascular involvement 4.9%. Hospitalisation in a closed unit 14.05%, mortality 2.48%.

CONCLUSION

Relapse of disease and infections were the main reasons for hospitalisation; admission secondary to infection was higher than that reported in other series.

Causes of Hospitalization for Systemic Lupus Erythematosus in Saudi Arabia Compared With the Global Setting: A Retrospective Single-center Observational Study

BACKGROUND

This study sought to evaluate the main causes of hospitalization of patients with systemic lupus erythematosus (SLE) in a tertiary health center in Saudi Arabia.

METHODS

A retrospective observational study was performed for all the SLE patients admitted to King Saud Medical City between 2016 and 2019. The primary reason for hospitalization was determined by the primary physician caring for the patient at the time of admission.

RESULTS

Of the 98 hospitalizations for SLE, 49% of patients were admitted from the emergency department (ED) and 51% from the rheumatology clinic. The most common reason for hospitalization was lupus flare (68.4%) followed by infection (20.4%). The lupus flare patients commonly presented with musculoskeletal (MSK)symptoms (34.6%), renal manifestations (25.5%), and skin rash (24.5%), whereas patients admitted with infection were commonly diagnosed with community-acquired pneumonia (12.2%). Other hospitalization causes were obstetric complications, adverse drug reactions, and thrombosis. Intensive care unit (ICU) admission was necessary for 7% of patients due to acute respiratory distress syndrome (ARDS) and pulmonary hemorrhage (28.6%) or other reasons (14.1%), such as pleural effusion, cardiac tamponade, and thrombotic thrombocytopenic purpura (TTP). Conclusions: The two most common reasons for SLE hospitalization were lupus flare and infection. Lupus flare was mainly due to MSK, renal, and dermatologic manifestations. The most common infection leading to hospitalization was community-acquired pneumonia, and ICU admission was mainly due to ARDS and pulmonary hemorrhage.

The SLICC/ACR Damage Index (SDI) may predict adverse obstetric events in patients with systemic lupus erythematosus

OBJECTIVE

The objective of this study was to evaluate the potential impact of irreversible damage accrual in women with systemic lupus erythematosus (SLE) and adverse maternal and/or fetal/neonatal outcomes.

METHODS

Retrospective cohort study with SLE pregnant patients was carried out from January 2011 to January 2020 at the Hospital University Pedro Ernesto (HUPE) of the State University of Rio de Janeiro, Brazil. Irreversible damage was defined according to SLICC/ACR damage index (SDI). The association of SDI on pregnancy outcomes was established by univariate and multivariate regression models and included demographic and clinical variables.

RESULTS

This study included data from 260 patients in their first pregnancies after SLE diagnosis, with a quarter of them (67/260) scoring one or more points on SDI at the beginning of prenatal care. These patients presented more frequently adverse maternal events, namely, disease activity during pregnancy (p = 0.004) and puerperium (p = 0.001), active lupus nephritis (p = 0.04), and hospitalizations (p = 0.004), than those with no SDI score. Similarly, the risks of adverse fetal and neonatal outcomes were also higher among the patients with SDI ≥ 1 (59.7% vs 38.3% p = 0.001) even after controlling data for disease activity (SLEPDAI > 4). Patients with SDI ≥ 1 presented more frequently preterm deliveries (46.3% vs 31.6%; p = 0.01), small for gestational age infants (28.3% vs 18.1%; p = 0.04), and neonatal intensive care unit admission (26.9% vs 1.5%; p < 0.001). The multivariate analyses showed that SDI ≥ 1 is an independent risk factor for hospitalization due to obstetric complications (p = 0.0008) and preterm delivery (p = 0.009).

CONCLUSION

Pregnant SLE patients who present irreversible damage accrual may have higher risk of maternal and fetal adverse outcomes, independently of disease activity. These results should be validated in further prospective studies.

Hospitalization in patients with systemic lupus erythematosus at Tawam Hospital, United Arab Emirates (UAE): Rates, causes, and factors associated with length of stay

INTRODUCTION

Systemic lupus erythematosus (SLE) is a relapsing and remitting multiorgan disease associated with significant morbidity and mortality. The survival rate of patients with SLE has recently improved, which was associated with increased morbidity and hospitalization rates. Therefore, this study aimed to examine the rate and causes of hospitalization in patients with SLE and explore factors associated with increased length of stay (LOS).

METHODS

Patients who visited rheumatology clinics (Tawam hospital, United Arab Emirates (UAE)) and fulfilled the American College of Rheumatology (ACR) SLE criteria were identified. Retrospective charts were reviewed to determine previous admissions. Demographic data, reason for hospitalization, duration of hospitalization, intensive care unit (ICU) admission, number of specialist consultations, medications used, and SLE characteristics at time of admission were collected. The hospitalization rate was calculated as the number of hospitalized patients divided by the total number of patients with the disease. We performed multivariable regression analysis for factors associated with increased LOS.

RESULTS

A total of 91 patients with SLE (88 women and 3 men) met the inclusion criteria with a mean disease duration of 10.2 years (SD 5.5). A total of 222 admissions were identified, and 66 of 91 patients were admitted at least once. The mean crude hospitalization rate calculated was 29.8%. The primary reason for admission was pregnancy (29%), SLE activity (24%), and infection (20%). When combining primary and secondary reasons, the proportion of admissions due to SLE activity increased to 32%. The mean LOS was 5.9 (SD 6.0) days. About 7% of admitted patients required ICU admission. In multivariable analysis, patients with lupus nephritis, complications during hospitalization, and increased number of specialists consultations and who were admitted to ICU and started new medication were all associated with increased LOS.

CONCLUSION

A significant proportion of patients with SLE were hospitalized during their disease course. The hospitalization rate in this study appears to be higher than those reported elsewhere. Disease flare is the leading cause of admission in patients with SLE in this relatively young cohort. Lupus nephritis has been found to be significantly related to longer LOS. Measurements taken to reduce the incidence and severity of flares would likely decrease hospitalization rate and LOS in patients with SLE.

Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI)

OBJECTIVE

The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in SLE, but its association with hospitalizations has not been described. We estimated the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.

METHODS

Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in hospital. Multivariable models were adjusted for relevant baseline characteristics.

RESULTS

The 1549 SLE patients eligible for this analysis were mostly female (88.7%) with mean (SD) age 35.7 (13.3) years and median (IQR) disease duration 1.2 (0.9-1.5) years at baseline. Mean (SD) baseline SLICC-FI was 0.17 (0.08). During mean (SD) follow-up of 7.2 (3.7) years, 614 patients (39.6%) experienced 1570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up (Incidence Rate Ratio 1.21; 95%CI 1.13-1.30), adjusting for baseline age, sex, corticosteroid use, immunosuppressive use, ethnicity/location, SLE disease activity index 2000 (SLEDAI-2K), SLICC/ACR damage index (SDI), and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (Relative Rate 1.09; 95%CI 1.02-1.16).

CONCLUSION

The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

Early damage as measured by SLICC/ACR damage index is a predictor of hospitalization in systemic lupus erythematosus (SLE)

BACKGROUND

Hospital admissions and re-admissions in lupus patients are common occurrences that can lead to poor prognosis.

OBJECTIVES

We evaluated the leading causes of all-cause hospitalizations and their predictive factors in the Malaysian multi-ethnic SLE patients.

METHODS

This is a retrospective study involving 300 SLE patients. Demographic data and details of hospitalizations from the year 1988 until 2019 were reviewed. Baseline and latest disease activity (SLEDAI-2 K) and SLICC/ACR damage index (SDI) scores were evaluated. To be eligible for this study, their SLE diagnosis and disease duration was at least one year; this is to ensure that the baseline disease damages were measured at least after 6 months of diagnosis and subsequent disease damage indexes were captured.

RESULTS

Majority were of Chinese ethnicity 150 (50%). The cohort's median age was 48 (18-82) years and median disease duration was 13 (1-52) years. 133 (44.3%) had SDI score of ≥1 at baseline (early damage). 69 (23%) had developed new organ damage during this study period.There were 222 (74%) patients ever hospitalized from this cohort. The main cause of hospitalization was lupus flare which included concurrent infection (n = 415 admissions, 46%), followed by elective admissions for procedures and others (n = 284 admissions, 31.5%). Admissions for treatment and disease related complications were 13.8%. 8.7% of admissions were due to infections alone. Median length of stay for SLE-related cause admissions was longer compared to non-SLE related causes. Jointly predictive factors for hospitalization were anti-phospholipid syndrome (OR 5.82), anti-Smith (OR 6.30), anti-SSA (OR 3.37), serositis (OR 14.56), neurological (OR 5.52) and high baseline SDI (OR 1.74), all p < 0.05.

CONCLUSION

Early damage in lupus as measured by SDI is a predictive value of hospitalization. Optimization in managing patients with pre-existing damage is crucial to reduce hospitalization risk and subsequent complications.

Causes of Hospitalization in Systemic Lupus Erythematosus: A Narrative Review

Hospitalizations are frequent in Systemic Lupus Erythematosus (SLE) and carry a significant economic burden. The focus of this review was to summarize the information available on the main causes of SLE hospitalizations over recent decades. A literature review was conducted, using PubMed and Scopus, for articles related to SLE hospital admissions from 1981 onward. Active disease/ flare and infection were the leading causes of admission across the study period. More recently, other comorbidities gained relevance, such as cardio and cerebrovascular disease, pregnancy-related morbidity, adverse drug reactions, thromboembolic events, malignancy and renal, pulmonary and gastrointestinal disease. African and Southeast Asian studies seemed to display particularly high percentages of patients admitted with active disease/flare, while European and North American studies appeared to report more admissions due to comorbidities and accumulated disease/treatment damage. Some data support a temporal change of certain admission causes, but the limited number, heterogeneity and variance among studies weakens a consistent analysis. In conclusion, despite the developments in SLE management, causes of hospitalization have not prominently changed across recent decades.

Reasons for Hospitalisation in Patients with Systemic Lupus Erythematosus in a University Hospital in Buenos Aires

OBJECTIVE

To determine the reasons for hospitalisation in patients with systemic lupus erythematosus (SLE) admitted to the Hospital de Clínicas «José de San Martín» Buenos Aires, Argentina.

METHODS

We retrospectively analysed the clinical histories of SLE patients (SLICC 2012) during or prior to hospitalisation, from 1-2014 to 12-2017. Demographic data, reasons for hospitalisation, treatments, SLEDAI-2K and comorbid conditions.

RESULTS

121 hospitalisations corresponding to 72 patients, 25 patients (34.7%) were hospitalised more than once. Females (83.3%), the median length of disease until admission was 5 years. There was more than one reason for hospitalisation in 32, a total of 164 reasons. The main reason was relapse of disease (52.4%). The most frequent manifestations were renal involvement, serositis and pulmonary involvement. Infections were the second reason for hospitalisation (26.8%); urinary tract, pneumonia and soft tissue. Cardiovascular involvement 4.9%. Hospitalisation in a closed unit 14.05%, mortality 2.48%.

CONCLUSION

Relapse of disease and infections were the main reasons for hospitalisation; admission secondary to infection was higher than that reported in other series.

All-cause hospitalizations and mortality in systemic lupus erythematosus in the US: results from a national inpatient database

Systemic lupus erythematosus (SLE) is a multisystem disorder. While several studies have outlined risk factors for hospitalization and mortality in SLE; the frequency of hospitalizations from various causes has varied among studies and over the years. We aimed to assess the causes of SLE hospitalizations and inpatient mortality compared to those without SLE in the United States in a recent year (2016) using a large national inpatient database. We used National Inpatient Sample (NIS) to identify hospitalizations with SLE using the ICD-10 code M32. Among hospitalizations with SLE as secondary diagnosis, we used ICD-10 codes to assess the primary diagnoses associated with hospitalizations and mortality. Our study included 174,105 SLE hospitalizations matched to controls (similar age, sex, and NIS stratum) in the year 2016. Mean age of hospitalization with SLE was 51.82 years, and 89% of hospitalized SLE patients were females. Mean length of stay, cost and mortality for SLE were 5.6 ± 7.2 days, US $ 14,450 and 1.96%, respectively. SLE was the primary diagnosis in 10,185 (5.85%) of all SLE related hospitalizations. Among SLE hospitalizations, infection was the most common primary diagnosis (15.80%) followed by cardiac and renal manifestations (7.03% and 4.91% respectively). Infection was the leading cause of mortality (38.18%) followed by cardiac manifestations (12.04%). Infections and cardiac involvement were the leading causes of hospitalizations and in-hospital mortality in SLE. Whether this is related to the disease itself, its associated comorbidities or immunosuppressive agents would require further studies.

Causes and Factors Associated with Frequent Hospitalization in Chinese Patients with Systemic Lupus Erythematosus: An Ambispective Cohort Study

Background

Hospitalizations in patients with systemic lupus erythematosus (SLE) have been reported from different regions in the world. This study aimed to evaluate the annual hospitalization rate, causes of hospitalization, and potential factors associated with frequency of hospitalization in Chinese patients.

Material/Methods

We performed an ambispective cohort study for hospitalized patients with SLE in a Chinese single center. Data on demographics, organ involvements, laboratory abnormities, clinical treatments, causes of hospitalization, and survival outcomes were recorded at the time of SLE diagnosis and during a follow-up period. Poisson regression models were created to identify the potential factors associated with frequency of hospitalization.

Results

Of 526 patients with SLE, 242 patients (46%) had 1 or more admissions amounting to a total of 449 times during a median follow-up period of 4.73 years. The annual hospitalization rate was 18% and death occurred in 2.5% of total admissions. SLE flare, infection and pregnancy-related morbidity were the most common causes of hospitalization. Besides, the multivariate Poisson regression analysis revealed that decreased albumin, decreased renal function, and high disease damage were the risk factors for more frequency of hospitalization, whereas positive anti-SSA antibody and use of hydroxychloroquine were protective factors.

Conclusions

Nearly half of patients (46%) with SLE experience 1 or more hospitalizations, mainly due to SLE flare, infection, and pregnancy-related morbidity. Lupus patients with decreased albumin, decreased renal function, and high disease damage are more susceptible to have frequent hospitalization.

Causes and factors related to hospitalizations in patients with systemic lupus erythematosus: analysis of a 20-year period (1995-2015) from a single referral centre in Catalonia

INTRODUCTION

Although extensively characterized in the outpatient setting, systemic lupus erythematosus (SLE) in the hospitalization wards is still scarcely portrayed, particularly in the perspective of its evolution over the years.

METHODS

Retrospective analysis of SLE patients hospitalized in the Department of Autoimmune Diseases of a university hospital during a 20-year period (1995-2015), describing hospitalization characteristics, causes and predictors of outcome.

RESULTS

A total of 814 hospitalizations concerning 339 patients were analysed. The main causes of admission were flare (40.2%), infection (19.2%), diagnostic procedures (18.8%) and thrombotic events (5.4%). Therapy with cyclophosphamide (odds ratio (OR) 1.908, p = 0.047) was associated with admission due to infection, while antimalarials displayed a protective effect (OR 0.649, p = 0.024). Nearly 3.9% of patients required admission to an intensive care unit, with associated antiphospholipid syndrome (OR 7.385, p = 0.04) standing as a predicting factor for this outcome. Readmission at 30 days occurred in 5.8% of patients, with thrombocytopenia (OR 6.007, p = 0.002) and renal involvement (OR 3.362, p = 0.032) featuring as predicting factors. Eight patients died, with antiphospholipid syndrome (OR 26.814, p = 0.02) and thrombocytopenia (OR 31.523, p = 0.01) being associated with mortality. There was no significant variation in patients' demographics or admission causes across the 20-year period, except for a decrease in admissions due to thrombotic and musculoskeletal causes. Recently, an increase in the use of mycophenolate mofetil and lower doses of glucocorticoids were noted.

CONCLUSION

While demographics of SLE hospitalizations have not markedly changed over the past 20 years, changes in therapy patterns were observed. Thrombocytopenia, antiphospholipid syndrome and renal involvement featured as predictors of poor outcome.

All-cause hospitalizations in systemic lupus erythematosus from a single medical center in Israel

OBJECTIVE

Clinical features of systemic lupus erythematosus (SLE) have been described from different geographical regions in the world. The aim of this study was to obtain local and contemporary data on all-cause hospitalizations of SLE patients in an Israeli Medical Center.

METHODS

This is a retrospective observational single-center study. Revision of medical records of hospitalized lupus patients during 5-year period (January 2012-December 2016) was performed.

RESULTS

A total of 61 lupus patients and 138 hospitalizations were identified. Female-to-male ratio was 9:1. Average age was 42.5 years. Average disease duration was 14.58 years. Mean SLICC/ACR damage index was 0.75. The majority of patients were treated with lupus medications (47, 77%). The most common lupus medications were hydroxychloroquine (40, 65.5%), prednisone (25, 40.9%), and azathioprine (9, 14.75%). The most common reasons for hospitalization were disease flare (28, 20.3%), pregnancy and labor (26, 18.9%), and infection (19, 13.8%). The average length of hospitalization for all patients was 6.65 days. No fetal morbidity was recorded, and there was one event of maternal morbidity. There were no cases of acute coronary events. There were six ICU admissions (4.35%). Two admissions (1.45%) were complicated by hospital-acquired infection. Three patients died (2.17%) during hospital stay.

CONCLUSIONS

This survey from a single Israeli medical center revealed low rates of pregnancy complications, coronary events, and nosocomial infections in hospitalized lupus patients. Further studies are required to determine whether these findings reflect local disease expression or it may remark global trend of decrease in lupus complications.

Predictors and outcome of systemic lupus erythematosus (SLE) admission rates in a large teaching hospital in sub-Saharan Africa

Although it was previously believed that systemic lupus erythematosus was uncommon among Africans, it has become increasingly apparent that the incidence is higher, and socioeconomic challenges such as physician shortages, poor medical facility access, and poor health literacy may worsen prognosis. This retrospective study examines characteristics and outcomes of hospitalized systemic lupus erythematosus patients over a two-year period and serves as a baseline for comparison for future studies to examine the outcomes with the provision of more dedicated care. There were 51 patient admissions over a two-year period, with a mean duration from start of illness to admission of approximately two years. Duration of admission ranged from one to 140 days with a mean period of 26.12 days (SD ± 26.6). There were 22 deaths (43.1% of admissions), which were mainly due to infections and renal complications. Factors associated with risk of death in regression analysis were: infections, fever, disease flare, musculoskeletal involvement, amenorrhea, depression, a clinical finding of hepatomegaly, and chest infection. Understanding the effect and outcome of systemic lupus erythematosus across different countries can elucidate the role of genetic, environmental, and other causative factors in the progression of the disease.

Hospitalizations among Danish SLE patients: a prospective study on incidence, causes of admission and risk factors in a population-based cohort

Objective To determine the incidence, duration and cause of hospitalization in a cohort of Danish patients with systemic lupus erythematosus (SLE). In addition, we investigated risk factors for admission and prolonged hospital stay. Methods A total of 155 SLE patients from a population-based cohort were included in the study during a period of 70 months, from January 2007 to October 2012. Data on frequency, cause and duration of hospitalizations were obtained by review of medical charts. Data on disease manifestations, organ damage and treatment were collected prospectively. Results A total of 101 of the 155 SLE patients (65%) had one or more hospitalization during the study period. The incidence rate of all hospitalizations was 0.50 per year. Leading causes of admission were complications to SLE or its treatment, but infections were also common. Mean duration of hospital stay was 6.4 ± 10.5 days, and SLE Disease Activity Index 2000 (SLEDAI-2K) on admission emerged as a risk factor for prolonged hospital stay. Conclusion Danish SLE patients experience frequent admissions to hospital. Complications to SLE or its treatment, as well as infections, are leading causes of admission. High SLEDAI-2K on admission is a risk factor for prolonged hospital stay.