Background/Purpose: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organs in the body, including the heart, kidney and lung, leading to increasing damage over time.  Hospitalizations associated with organ damage in SLE patients across Canada have not been previously reported.  The purpose of this study was to describe trends and provincial variations in hospitalizations due to organ damage in SLE patients in Canada between 2006-2010.

Methods: Aggregate hospitalization data for most common organ manifestations (kidney, lung, pericarditis, Libman-Sacks disease) associated with SLE was obtained from the Canadian Institute for Health Information’s (CIHI) Discharge Abstract and Hospital Morbidity database, based on ICD – 10 coding, for 2006-2010. Hospitalizations associated with organ damage were reported as a function of total hospitalizations due to SLE in Canada.  Provincial data was grouped into geographical regions for ease of reporting.  Length of stay (LOS) was categorized and reported by gender and province.

Results: Overall, total count of hospitalizations due to organ damage decreased over the study period (2006: 525; 2010: 416).  Hospitalization due to kidney involvement was the most common reason for all SLE hospitalizations in Canada (2006: 48.2%; 2010: 41.7%), followed by lung involvement (2006: 9.1%; 2010: 6.8%), pericarditis (2006: 5.2%; 2010: 6.2%), Libman Sacks (2006: 0.6%; 2010: 0.5%), and other (2006: 36.9%; 2010: 44.8%). In all provinces, hospitalizations due to kidney involvement accounted for almost half of all SLE hospitalizations:  BC reported the highest rates in 2006 (52.4%), but falling by 2010 (42.7%).  A decreasing trend in SLE hospitalizations due to kidney involvement was seen in all provinces, except the Maritimes.  Hospitalizations due to lung involvement showed the highest decrease in BC between 2006 (13.5%) and 2010 (4.9%): similar decreases were seen in other provinces and Canada-wide (2006: 9.1%; 2010: 6.8%). In contrast, hospitalizations due to lupus pericarditis increased over this time period, with the highest increase recorded in BC (2006: 2.4%; 2010: 8.4%).  There was an increasing trend for patients with kidney involvement to stay longer in hospitals (12+ days; 2006: 33.2%; 2010: 35.6%), when compared to LOS due to any SLE-related hospitalizations (2006: 29%; 2010: 26.6%).  Overall, more females than males were hospitalized for organ involvement, but males LOS was longer. Limitations to the study include the possibility of double counting events due to a lack of patient level data.

Conclusion: Kidney involvement accounted for almost half of all hospitalizations related to SLE in Canada, consistent with reported higher incidences of lupus nephritis (1-3).  Overall, trends in hospitalizations tended to decrease over the time period, suggesting possibly better care of SLE patients.  However, when patients did enter hospital, they tended to stay longer, which may suggest that with current medications, disease progression continues and may lead to greater downstream costs in the Canadian health care system.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trends-in-hospitalizations-due-to-organ-damage-in-patients-with-systemic-lupus-erythematosus-in-canada-2006-2010/