Background/Purpose: Hospitalizations are one of the major direct costs in SLE.  A review of studies looking at the contributions of different medical components to the economic burden of SLE revealed that hospitalizations may count for 50% of the direct costs in SLE (Panopalis P, et al. Arthritis Rheum 2008; 59:1788–1795.).  Lupus nephritis has been identified as one of the significant factors consistent with increased direct costs (Slawsky KA et al. Arthrit Care Res 2011; 63:1224-1232.).  Identification of predictors of hospitalizations could lead to targeted interventions to reduce costs.

Methods: The medical resource use questionnaire was distributed to SLE patients in the Hopkins Lupus Cohort that covered the last 3 months before the baseline visit and then at the following two quarterly clinic visits. 359 patients (91% female, 55% Caucasian, 36% African-American, 9% other ethnicities, mean age at baseline 46±12 years) were included in the analysis.  Exclusion criteria were diagnosis with lupus less than 6 months ago, age younger than 18 or older than 75, pregnant at baseline, and active HIV patients.

Results:

Univariate analysis identified prednisone, disease activity (mean Physician’s global assessment, SLEDAI), and renal lupus as predictors of hospitalization over the next 6 months (Table 1). In the multivariate model for number of hospitalizations, use of prednisone at baseline and mean SLEDAI were associated (Table 2).

We next looked at hospitalizations due to lupus. In a multivariate linear regression model, baseline hospitalizations and mean SLEDAI were predictive.

Table 1. Predictors of hospitalizations (any vs none) – univariate analysis.

 

¹PGA: Physician’s global assessment (0-3 scale)

Table 2.  Multivariate Linear Regression Model.

	Effect on number of hospitalizations	P-value
Age at baseline (per 10 years)	0.04±0.02	0.061
Ethnicity (African-American)	0.06±0.06	0.25
Education (<12 years)	-0.05±0.10	0.61
Use of prednisone at baseline	0.14±0.06	0.0091
Mean SLEDAI (per unit)	0.03±0.01	0.0086
Urine Pr:Cr ratio at baseline (per unit)	0.01±0.04	0.73

Conclusion: Total hospitalizations are associated with prednisone use and disease activity. Hospitalizations due to SLE were also associated with disease activity captured by SLEDAI. Targeted therapies that reduce SLEDAI would thus be expected to reduce hospitalizations and direct costs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hospitalizations-in-systemic-lupus-erythematosus-a-longitudinal-study/