University of Alabama at Birmingham and Birmingham VA Medical Center.
University of Alabama at Birmingham.
Arthritis Rheumatol. 2021 Apr;73(4):617-630. doi: 10.1002/art.41577. Epub 2021 Mar 5.
To examine the time trends in hospitalized infections in patients with systemic lupus erythematosus (SLE), and the factors associated with health care utilization and in-hospital mortality.
US National Inpatient Sample data from 1998-2016 were used to examine the epidemiology, time trends, and outcomes of 5 common hospitalized infections in patients with SLE, namely, pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), and opportunistic infections (OIs). Time trends were compared using the Cochran-Armitage test. Multivariable-adjusted logistic regression models were used to examine the factors associated with health care utilization (hospital stay >3 days, hospital charges above the median, or discharge to a nonhome setting) and in-hospital mortality.
Hospitalization rates per 100,000 claims among SLE patients in 1998-2000 versus in 2015-2016 were as follows: for OIs, 1.13 versus 1.61 (1.2-fold increase); for SSTIs, 4.78 versus 12.2 (2.5-fold increase); for UTI, 1.94 versus 6.12 (3.2-fold increase); for pneumonia, 15.09 versus 17.05 (1.1-fold increase); and for sepsis, 6.31 versus 39.64 (6.3-fold increase). In 2011-2012, sepsis surpassed pneumonia as the most common hospitalized infection in patients with SLE. In multivariable-adjusted models, a diagnosis of sepsis, older age, a Deyo-Charlson common comorbidities score of ≥2, having Medicare or Medicaid insurance, and urban hospital location were significantly associated with increased odds of in-hospital mortality and with all health care utilization outcomes. African American race was significantly associated with increased odds of health care utilization.
The results of this study indicate that the rates of hospitalized infections increased over time in patients with SLE, and that pneumonia was surpassed by sepsis as the most common hospitalized infection. In addition, associations of risk factors with poorer outcomes were identified. These findings may help inform patients, providers, and policy makers with regard to the burden of infection in SLE, and could lead to interventions/pathways to improve outcomes.
研究系统性红斑狼疮（SLE）患者住院感染的时间趋势，以及与医疗保健利用和住院死亡率相关的因素。
使用 1998-2016 年美国国家住院患者样本数据，研究 5 种常见住院感染（肺炎、败血症/菌血症、尿路感染、皮肤软组织感染和机会性感染）在 SLE 患者中的流行病学、时间趋势和结局。使用 Cochran-Armitage 检验比较时间趋势。多变量调整逻辑回归模型用于研究与医疗保健利用（住院时间>3 天、住院费用高于中位数或出院到非家庭环境）和住院死亡率相关的因素。
1998-2000 年与 2015-2016 年 SLE 患者每 10 万例索赔中的住院率如下：机会性感染为 1.13 比 1.61（增加 1.2 倍）；皮肤软组织感染为 4.78 比 12.2（增加 2.5 倍）；尿路感染为 1.94 比 6.12（增加 3.2 倍）；肺炎为 15.09 比 17.05（增加 1.1 倍）；败血症为 6.31 比 39.64（增加 6.3 倍）。2011-2012 年，败血症超过肺炎成为 SLE 患者最常见的住院感染。在多变量调整模型中，败血症的诊断、年龄较大、Deyo-Charlson 常见合并症评分≥2、有医疗保险或医疗补助保险以及位于城市医院与住院死亡率和所有医疗保健利用结局的较高几率相关。非裔美国人种族与医疗保健利用几率增加显著相关。
本研究结果表明，SLE 患者住院感染的发生率随时间推移而增加，肺炎被败血症超过成为最常见的住院感染。此外，还确定了与较差结局相关的危险因素。这些发现可能有助于向患者、提供者和决策者提供有关 SLE 感染负担的信息，并可能导致干预措施/途径以改善结局。
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