Background/Purpose:

Sepsis is a systemic inflammatory response syndrome caused by an infection with at least one acute organ failure and is major public health concern.¹ Serious infectious diseases are recognized as major causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Hospitalization of patients with SLE is a major cause of healthcare costs², but limited research is available examining cost differences of complications associated with lupus including severe infections and sepsis.

Methods:

We analyzed hospitalizations for sepsis among adults in the Nationwide Inpatient Sample (NIS). Patients were stratified into two groups based on the status of SLE; using ICD-9 CM diagnostic codes. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted multivariate regression analysis was used to adjust for confounders when calculating length of stay and total charges.

Results:

There were an estimated 35475 adult hospitalizations for sepsis with secondary diagnosis of lupus, from 2010 to 2014. On univariate analysis, the average age of patients admitted with sepsis in the general population was 67.154 ±0.064 years, whereas in the SLE population, the average age was 54.145 ± 0.225 years (p<0.0001). Among the general population, 51.47% of all patients with sepsis were females; whereas among the SLE population, 87.79% of the population were females (p<0.0001). Septic patients with secondary diagnosis of lupus had significantly higher length of stay and total cost per hospitalization. When adjusted for patient factors affecting population with SLE including age, gender and race, length of stay was still found to be significantly high by a coefficient of 0.27 (p value =0.01). Similar results were noted in total hospital cost with average $3541 increase in charges, for patients with sepsis and lupus, when adjusted for age, gender and race.

Conclusion:

From our study, SLE is associated with higher cost burden and length of stay in patients admitted with sepsis. This may reflect decreased immune response from the disease itself as well as use of immunosuppressive drugs, resulting in longer stay in hospitals. Inpatient hospital charges associated with sepsis can be decreased with early and aggressive intervention. Rheumatology providers should have low threshold to screen patients for infections to prevent progression of infections to sepsis. This will help reduce healthcare utilization and costs in patients with underlying SLE.

References:

1. Torio CM et al. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2013 Aug; http://www.ncbi.nlm.nih.gov/books/NBK169005/
2. Anandarajah AP et al. Lupus. 2017 Jun;26(7):756-761. doi: 10.1177/0961203316676641. Epub 2016 Nov 12. PubMed PMID: 27831537.

Table 1: Characteristics of patients admitted with Sepsis with secondary diagnosis of SLE from 2010-2014

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-length-of-stay-and-total-hospital-charges-for-hospitalizations-for-sepsis-in-patients-with-systemic-lupus-erythematosus-a-study-of-national-inpatient-sample-database-2010-to-2014/