Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA.
Division of Rheumatology, VA San Diego Health Care System, San Diego, California, USA.
Lupus Sci Med. 2023 Apr;10(1). doi: 10.1136/lupus-2022-000851.
Care of young adults with SLE (YA-SLE, 18-24 years) is challenging due to major life transitions co-occurring with chronic healthcare needs. Studies have demonstrated poorer outcomes in the post-transition period. Epidemiological studies focused on serious infection-related hospitalisation (SIH) in YA-SLE are lacking.
We used National Inpatient Sample from 2010 to 2019 to study the epidemiology and outcomes of SIH for five common infections in SLE, namely sepsis, pneumonia, urinary tract infections, skin and soft tissue infections, and opportunistic infections. For time trends, we extended the dataset to cover 2000-2019. The primary outcome was the rate of SIH in YA-SLE compared with adults (25-44 years) with SLE and with young adults without SLE (YA-no SLE).
From 2010 to 2019, we identified 1 720 883 hospital admissions with SLE in patients aged ≥18 years. Rates of SIH were similar in young adults and adults with SLE (15.0% vs 14.5%, p=0.12), but considerably higher than in the YA-no SLE group (4.2%, p<0.001). Among SLE with SIH, sepsis followed by pneumonia was the most common diagnosis. Significantly higher proportions of SIH among young adults than adults with SLE were comprised of non-white patients, belonged to the lowest income quartile and had Medicaid. However, only race/ethnicity was associated with SIH among YA-SLE. There was a higher prevalence of comorbid lupus nephritis and pleuritis among young adults compared with adults with SLE and SIH, and both comorbidities were associated with SIH in YA-SLE. Increasing rates of SIH, driven by sepsis, were seen over time.
YA- SLE had similar rates of SIH to adults with SLE. While hospitalised YA-SLE differed sociodemographically from SLE adults and YA-no SLE, only race/ethnicity was associated with SIH in the YA-SLE group. Lupus nephritis and pleuritis were associated with higher SIH in YA-SLE. Among SLE with SIH, increasing trends of sepsis deserve further study.
由于年轻人在过渡期间面临重大生活转变，同时又存在慢性医疗需求，因此照顾患有 SLE（18-24 岁）的年轻人具有挑战性。研究表明，在过渡后期间的预后更差。目前缺乏针对 SLE 青少年过渡期间严重感染相关住院治疗（SIH）的流行病学研究。
我们使用 2010 年至 2019 年的国家住院患者样本，研究了五种常见感染（败血症、肺炎、尿路感染、皮肤和软组织感染以及机会性感染）导致的 SLE 患者 SIH 的流行病学和结果。对于时间趋势，我们将数据集扩展到 2000-2019 年。主要结果是 YA-SLE 与 SLE 成人（25-44 岁）和无 SLE 的年轻成年人（YA-no SLE）相比 SIH 的发生率。
2010 年至 2019 年，我们在年龄≥18 岁的 SLE 患者中确定了 1720883 例住院患者。年轻患者和成人 SLE 患者的 SIH 发生率相似（15.0% vs 14.5%，p=0.12），但明显高于 YA-no SLE 组（4.2%，p<0.001）。在 SLE 合并 SIH 中，败血症继肺炎之后是最常见的诊断。与 SLE 成人相比，年轻患者 SIH 中所占比例较高的是白人以外的患者，收入最低的四分位数患者和 Medicaid 患者。然而，只有种族/民族与 YA-SLE 中的 SIH 相关。与 SLE 成人和 SIH 相比，年轻患者 SLE 中狼疮肾炎和胸膜炎的合并率更高，并且这两种合并症都与 YA-SLE 中的 SIH 相关。随着时间的推移，由败血症驱动的 SIH 发生率呈上升趋势。
YA-SLE 的 SIH 发生率与成人 SLE 相似。尽管 YA-SLE 在社会人口统计学上与 SLE 成人和 YA-no SLE 不同，但只有种族/民族与 YA-SLE 中的 SIH 相关。狼疮肾炎和胸膜炎与 YA-SLE 中的 SIH 发生率较高相关。在 SLE 合并 SIH 中，败血症呈上升趋势值得进一步研究。
