Background/Purpose:

There is scant information on the frequency, main causes and associated risk factors of hospitalization in patients with primary Sjögren syndrome (PSS).We aimed to identify the causes  and risk factors for hospitalization of PSS patients who attended a tertiary referral center.

Methods:

We identified all PSS patients who regularly attend our Rheumatology clinic from Jan 2000 to Apr 2013 and retrospectively collected demographic, clinical (parotid enlargement and extraglandular features) and serological (anti-Ro/SSA, anti-La/SSB, RF, low C3 or C4 ever and maximum globulin levels) data from medical records. Patients who required at least one hospital admission were compared with those who never were hospitalized. The Disease Damage Index (SSDDI) (excluding the oral and ocular items) and the Charlson comorbidity Index were also assessed. We used a logistic regression analysis.

Results:

We included a total of 170 patients (162 females, 95%). Fifty five (32%) patients were hospitalized, representing a total number of 111 hospitalizations (28 patients had more than one hospital admission). The hospitalization incidence density rate was 6.49/100 patient years. The median length of hospital stay was 9 days (IQR 6 – 15). There were 7 ICU admissions and 6 deaths. The main causes of admissions were disease activity in 37 cases (33.3%), infections in 36 patients (32.4%) and miscellaneous causes in 42 patients (34.3%). When compared to patients seen during the same time period and not admitted to hospital, those admitted had a shorter disease duration (6.3 [IQR 1.6-12.1] vs. 8.2 [IQR 4.6-14-1], p=0.015), similar age (55.97 ± 16.6 vs. 56.1 ± 14.2, p=0.96), a higher median SSDDI score (2 [IQR 0-2] vs. 0 [IQR 0-2], p=0.001) and higher proportion of patients with a Charlson comorbidity index ≥ 2 (36.4% vs. 15.6%, p=0.003).

The variables associated with hospitalization at the univariate analysis were vasculitis (20% vs. 7%, p=0.01), glomerulonephritis (9.1% vs. 0%, p=0.03), neurologic manifestations (polyneuropathy, mononeuritis or myelitis) (43.6% vs. 25.2%, p=0.02), hepatic involvement (primary biliary cirrhosis, autoimmune hepatitis and overlap syndrome) (21.8 vs. 5.2%, p=0.002) and hyperviscosity syndrome (7.2% vs. 1%, p=0.038). Hospitalized patients had higher median levels of globulins (4.2 [ IQR 3.4-5.7] vs. 3.8 [IQR 3.4-44], p=0.03), a higher prevalence of low C4 (16/41, 39% vs. 13/86, 15.1%, p=0.006) and less use of antimalarials (9.1% vs. 56.5%, p<0.001) and methotrexate (5.5% vs. 17.4%, p=0.03). At the multivariate analysis we identified the hepatic involvement (OR=5.01, 95% CI 1.02-24.39, p=0.046), globulin levels (OR=1.51, 95% CI 1.06-2.13; p=0.02) and low C4 (OR=4.85, 95% CI 1.54-15.30, p=0.007) as risk factors for hospitalization, whereas the use of antimalarials (OR= 0.08; 95% CI 0.02-0.27, p<0.001) was protective.

Conclusion:

Major causes for admission were disease activity and infection. The presence of serologic activity parameters such as higher levels of globulins, low C4 as well as the presence of hepatic involvement were risk factors associated with hospitalization; while the use of antimalarial seemed to protect.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hospitalization-in-patients-with-primary-sjogrens-syndrome/