Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States.

BACKGROUND

This study aimed to evaluate thrombotic microangiopathy's (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE).

METHODS

We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA.

RESULTS

Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients.

CONCLUSION

TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.