Division of Pediatric Rheumatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas 75390-9063, TX, United States.
Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, United States; Medical Service, VA North Texas Health Care System, Dallas, TX, United States; Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Semin Arthritis Rheum. 2021 Apr;51(2):353-359. doi: 10.1016/j.semarthrit.2021.02.001. Epub 2021 Feb 10.
The transition from pediatric to adult care is a vulnerable period for individuals with chronic diseases. We sought to identify risk factors associated with poor outcomes in patients with childhood-onset systemic lupus erythematosus (cSLE) who have transitioned to adult care.
A retrospective analysis of cSLE patients was performed. Outcomes of interest were development of end-stage renal disease (ESRD) or death and time to first hospitalization following final pediatric rheumatology visit. Multivariable logistic and Cox regression models were used.
Of 190 patients with cSLE, 21 (11%) developed ESRD and 9 (5%) died following the final pediatric rheumatology visit. In logistic regression, public insurance, history of Child Protective Services involvement, and an unscheduled hospitalization during the final year in pediatric care were predictive of ESRD or death (odds ratio (95% confidence intervals (CI)) 6.7 (1.5-30.7), 6.6 (2.3-19.1), and 3.2 (1.3-8.3), respectively). Among 114 patients with healthcare utilization data, 53% had a hospitalization in adult care. In Cox regression analysis, a pediatric outpatient opioid prescription was associated with shorter time to adult hospitalization and White or Asian race was associated with longer time to adult hospitalization (hazard ratio (CI) 3.5 (1.7-7.0) and 0.1 (0.03-0.4), respectively).
Risks factors associated with poor outcomes in adult care amongst patients with cSLE include public insurance, history of Child Protective Services involvement, unscheduled care utilization in pediatric care, pediatric outpatient opioid prescription, Black race and Hispanic ethnicity. Efforts to improve long-term outcomes among patients with cSLE should focus on these populations.
从儿科过渡到成人护理是慢性病患者的一个脆弱时期。我们试图确定与儿童期发病的系统性红斑狼疮（cSLE）患者过渡到成人护理后不良结局相关的风险因素。
对 cSLE 患者进行回顾性分析。感兴趣的结局是终末期肾病（ESRD）或死亡以及最后一次儿科风湿病就诊后首次住院的时间。使用多变量逻辑回归和 Cox 回归模型。
在 190 例 cSLE 患者中，21 例（11%）在最后一次儿科风湿病就诊后发生 ESRD，9 例（5%）死亡。在逻辑回归中，公共保险、儿童保护服务（Child Protective Services，CPS）参与史和儿科护理最后一年的非计划住院与 ESRD 或死亡相关（比值比（95%置信区间（CI））为 6.7（1.5-30.7）、6.6（2.3-19.1）和 3.2（1.3-8.3））。在 114 例有医疗保健利用数据的患者中，53%在成人护理中住院。在 Cox 回归分析中，儿科门诊阿片类药物处方与成人住院时间较短相关，而白种人或亚洲人种族与成人住院时间较长相关（风险比（CI）为 3.5（1.7-7.0）和 0.1（0.03-0.4））。
cSLE 患者在成人护理中不良结局相关的风险因素包括公共保险、CPS 参与史、儿科护理中非计划护理利用、儿科门诊阿片类药物处方、黑人和西班牙裔。改善 cSLE 患者长期结局的努力应针对这些人群。
