Background/Purpose:

Pneumonia is the leading cause of mortality in RA patients. No research has been conducted on the prognosis of pneumonia in RA patients. This study aimed to investigate the prognostic factors for RA patients hospitalized due to pneumonia.

Methods:

This study used data from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. We reviewed the abstract data and medical actions between 2014 and 2016, and identified RA patients with pneumonia who received RA treatment (conventional synthesis DMARD [cs-DMARD] or biological and targeted synthetic DMARD [b/ts-DMARD]) before admission within 8 weeks. We examined the predictor of in-hospital mortality and worsening of activities of daily living (ADL) from before admission and readmission to after discharge. The covariate included the patients’ background data (age, sex, body mass index (BMI), etc.), RA treatment (cs-DMARD alone, b/ts-DMARD, or corticosteroids), assessment of ADL (Barthel index), comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, coronary heart disease, cancer, hypertension, and chronic renal disease), a history of hospitalization for pneumonia within a year, and pneumonia severity at admission. Predictors were identified using a multiple logistic regression analysis.

Results:

For this study, 2951 patients from 194 hospitals were eligible. Of these patients, 560 (19%) received b/ts-DMARD. The multivariate analysis revealed that severe ADL impairment at admission (odds ratio [OR], 95% confidence interval [CI]: 9.12, 2.26–33.2), severe pneumonia severity (3.13, 1.92–5.11), and male sex (1.98, 1.12–3.51) were independent risk factors of in-hospital mortality. Use of b/ts-DMARD (OR, 95% CI: 0.93, 0.56–2.27) and corticosteroids (1.45, 0.66–3.02) just before admission was not associated with increased risk of in-hospital mortality as compared with cs-DMARD alone after adjustment for covariates. The risk of ADL worsening at discharge was slight to moderate ADL impairment at admission (OR, 95% CI: 2.81, 0.49–4.54). Use of b/tsDMARD was the factor that reduced the risk of ADL impairment at discharge (OR, 95% CI: 0.44, 0.22–0.80). The risk of readmission was male sex (OR, 95% CI: 2.55, 1.21–5.35), severe ADL impairment at admission (2.32, 1.01–5.11), and corticosteroid use (2.02, 1.04–3.84).

Conclusion:

The prognosis of pneumonia in RA patients was mainly associated with patient status on admission, patient sex, ADL, pneumonia severity, and BMI. The use of b/ts-DMARD immediately before admission was not attributed to increase in-hospital mortality and length of hospital stay and decreased risk of ADL impairment at discharge as compared with cs-DMARD alone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prognosis-of-pneumonia-in-rheumatoid-arthritis-patient-an-analysis-of-using-a-nationwide-administrative-database/