ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2827

Cervical Spine Fracture and Mortality in Ankylosing Spondylitis

Katherine D. Wysham1, Sara G. Murray2, Nancy K. Hills3, Edward H. Yelin4 and Lianne S. Gensler5, 1Internal Medicine, University of California, San Francisco, San Francisco, CA, 2Medicine, University of California, San Francisco, San Francisco, CA, 3Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 4Arthritis Research Group, University of California, San Francisco, San Francisco, CA, 5Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis IV - Clinical Aspects Axial Spondyloarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Little data exist regarding mortality in Ankylosing Spondylitis (AS) patients. We performed a population-based study of diagnoses associated with hospital mortality in AS. 

Methods: Data were abstracted from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) between 2007-2011. We identified hospital discharges with AS using a validated administrative definition. The primary outcome was mortality and we performed a subset analysis on cervical spine fracture (CSFX) associated conditions and fracture level. Chi-square and Wilcoxon rank sum tests were used when appropriate to identify diagnoses associated with mortality. Multivariable logistic regression, including socio-demographic variables, significant covariates and comorbidities, was performed to identify independent factors associated with in-hospital mortality.

Results: There were 12,493 AS admissions, 422 CSFXs and 276 deaths between 2007-2011. The mean age of all hospitalized AS patients was 59.2±16.4 years, 71% were males and 24% were electively admitted. The mean age of those with CSFX was 67.8±15.1 years, 91% were males and 11% were electively admitted. The mean age of those who died was 73.0±12.9 years, 78% were males and 10% were electively admitted. In the multivariable model, bacteremia and CSFX were the diagnoses with the highest odds of death, 7.28 (95% CI 5.36-9.88) and 5.70 (95% CI 3.63-8.95), respectively. Of those with CSFX, 66% also had a diagnosis of fall, though there was no interaction between CSFX and falls in predicting mortality. Motor vehicle accidents accounted for another 16% of CSFX cases. The majority of CSFX occurred at the lower cervical spine (75%). Regardless of level of fracture, 11% of patients died with associated CSFX.

Conclusion: The diagnoses most strongly associated with mortality in hospitalized AS patients, were bacteremia and CSFX. CSFX appears to be most commonly associated with falls and the majority of fractures occur in the lower cervical spine. This is the first population-based study describing the significant mortality associated with CSFX in AS patients. 

Table 1. Multivariable model of predictors of mortality in AS hospitalizations

Variable

Adjusted OR*

95% CI

P value

Age (per 1 year)

1.05

1.03-1.06

<0.001

Male Gender

0.97

0.71-1.33

0.87

Private insurance

0.77

0.53-1.11

0.16

Community population <50,000

1.38

1.02-1.87

0.04

Elective admission

0.58

0.38-0.88

0.01

Charlson Index (per 1 point on weighted scale)

1.25

1.18-1.34

<0.001

Bacteremia

7.28

5.36-9.88

<0.001

Pneumonia

1.98

1.44-2.70

<0.001

Cervical spine fracture

5.70

3.63-8.95

<0.001

Thoracic spine fracture

0.81

0.41-1.59

0.54

Lumbar spine fracture

1.88

0.81-4.41

0.14

Fall

0.98

0.63-1.51

0.92

*Odds ratios adjusted for all variables shown.

Disclosure:

K. D. Wysham,
None;

S. G. Murray,
None;

N. K. Hills,
None;

E. H. Yelin,
None;

L. S. Gensler,

UCB,

5,

AbbVie,

5,

Celgene Corporation,

9.

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