From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center.
J Rheumatol. 2018 Jul;45(7):929-933. doi: 10.3899/jrheum.170176. Epub 2018 Apr 15.
We investigated characteristics of adult patients with systemic lupus erythematosus (SLE) readmitted to the hospital within 30 days of discharge, in an attempt to identify the causes of early readmission.
We performed a retrospective case-control study examining all inpatient electronic health records of patients with SLE at Cedars-Sinai Medical Center over a 2.5-year period (2012-2014). Patients were included if they had an International Classification of Diseases, 9th ed diagnosis of SLE and were readmitted within 30 days of their initial hospitalization. Patients with SLE not readmitted during this time period were used as a control group. Demographic and clinical variables for each patient were collected, and we used the Charlson Comorbidity Index to characterize comorbidities. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to assess the chronic damage of SLE. Stepwise multivariable logistic regression analysis was used to predict factors associated with readmission.
In total, 570 hospitalizations representing 455 unique patients met our inclusion and exclusion criteria. Of these, 154 patients (34%) underwent readmission within 30 days of their initial hospitalization. Patients in the early readmission group were more likely to have government-sponsored Medicaid insurance and were significantly associated with an increased SDI (OR 1.27, 95% CI 1.1-1.48), lower serum hemoglobin (OR 0.82, 95% CI 0.72-0.93), and lower serum albumin (OR 0.66, 95% CI 0.47-0.91).
One-third of hospitalized patients with SLE were readmitted within 30 days at our institution. We identified characteristics of this at-risk population at time of discharge with high specificity, in hopes of reducing this costly outcome.
我们研究了系统性红斑狼疮（SLE）成年患者出院后 30 天内再次住院的特征，试图确定早期再入院的原因。
我们进行了一项回顾性病例对照研究，检查了 Cedars-Sinai 医疗中心 2.5 年内（2012-2014 年）所有 SLE 住院患者的电子病历。如果患者有国际疾病分类，第 9 版 SLE 诊断且在首次住院后 30 天内再次入院，则将其纳入研究。在此期间未再次入院的 SLE 患者作为对照组。收集每位患者的人口统计学和临床变量，并使用 Charlson 合并症指数来描述合并症。使用系统性红斑狼疮国际合作诊所/美国风湿病学会损伤指数（SDI）评估 SLE 的慢性损伤。采用逐步多变量逻辑回归分析预测与再入院相关的因素。
共有 570 次住院治疗代表 455 名独特患者符合我们的纳入和排除标准。其中，154 名患者（34%）在首次住院后 30 天内再次入院。早期再入院组患者更有可能拥有政府资助的医疗补助保险，与 SDI 增加显著相关（OR 1.27，95%CI 1.1-1.48），血清血红蛋白降低（OR 0.82，95%CI 0.72-0.93）和血清白蛋白降低（OR 0.66，95%CI 0.47-0.91）。
我们机构三分之一的住院 SLE 患者在出院后 30 天内再次入院。我们在出院时确定了这一高危人群的特征，希望降低这种昂贵的结果。
