Division of Rheumatology, Department and Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Institute of Mathematical Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia.
Lupus. 2020 Dec;29(14):1885-1891. doi: 10.1177/0961203320962848. Epub 2020 Oct 12.
Hospital admissions and re-admissions in lupus patients are common occurrences that can lead to poor prognosis.
We evaluated the leading causes of all-cause hospitalizations and their predictive factors in the Malaysian multi-ethnic SLE patients.
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.
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.
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.
狼疮患者的住院和再住院是常见现象，可导致预后不良。
我们评估了导致所有原因住院的主要原因及其在马来西亚多民族狼疮患者中的预测因素。
这是一项回顾性研究，涉及 300 名狼疮患者。回顾了 1988 年至 2019 年的人口统计学数据和住院详细信息。评估了基线和最新的疾病活动（SLEDAI-2K）和 SLICC/ACR 损伤指数（SDI）评分。为了符合本研究的条件，他们的狼疮诊断和疾病持续时间至少为一年；这是为了确保在诊断后至少 6 个月测量基线疾病损伤，并且随后捕获疾病损伤指数。
大多数患者为华裔 150 名（50%）。队列的中位年龄为 48 岁（18-82 岁），中位疾病持续时间为 13 年（1-52 年）。133 名（44.3%）患者在基线时有 SDI 评分≥1（早期损伤）。在此研究期间，有 69 名（23%）患者出现新的器官损伤。该队列中有 222 名（74%）患者曾住院治疗。住院的主要原因是狼疮发作，包括同时发生的感染（n=415 次住院，46%），其次是为了进行手术和其他治疗而选择性住院（n=284 次住院，31.5%）。因治疗和疾病相关并发症而住院的有 13.8%。因感染单独住院的占 8.7%。狼疮相关原因住院的中位住院时间长于非狼疮相关原因。共同的住院预测因素是抗磷脂综合征（OR 5.82）、抗 Smith（OR 6.30）、抗 SSA（OR 3.37）、浆膜炎（OR 14.56）、神经系统疾病（OR 5.52）和高基线 SDI（OR 1.74），所有 p 值均<0.05。
SDI 测量的狼疮早期损伤是住院的预测指标。优化对已有损伤患者的管理对于降低住院风险和随后的并发症至关重要。
