Background/Purpose:

Although the survival rate of patients with Systemic Lupus Erythematosus (SLE) has improved over the years, patients are frequently hospitalized or evaluated in the Emergency Room; these events account for most of the direct cost of these patients’ care. The objective of this study was to determine whether remission and low disease activity state (LDAS) are protective of hospitalizations and Emergency Room visits in our SLE patients.

Methods:

All hospitalizations and Emergency Room visits of Peruvian SLE patients members of a single center cohort were identified during the two-years following their baseline visit. We used the baseline data (at cohort entry) to determine which factors were associated with hospitalizations and Emergency Room visits in these patients. Remission was defined as a SLEDAI-2K=0, prednisone ≤5mg/d and immunosuppressants on maintenance dose, LDAS was defined as not on remission an a SLEDAI-2K≤4, prednisone ≤7.5mg/d and immunosuppressants on maintenance dose; antimalarials were allowed in both groups(1). Univariable and multivariable Poisson regression models were used to determine the impact of being on remission or LDAS on the risk of hospitalization and Emergency Room visits, adjusting for gender, age at diagnosis, socioeconomic status, disease duration, damage, comorbidities, time of exposure to prednisone and antimalarial use.

Results:

Of the 314 cohort patients, 92.7% (n = 291) were female, the median age of the patients was 40.7 (32.9-51.1) years, with a disease duration of 5.5 (2.6-10.3) years. Fifty-nine of the patients included were hospitalized, a total of 165 times (range 2.8 per patient). In the multivariable analysis we found that remission [RR 0.036 (0.005-0.259), p=0.001] and LDAS [RR 0.289 (0.182-0.457), <p=0.001] at baseline decrease the risk of hospitalization in SLE patients. Similarly, remission [RR: 0.019 (CI95%: 0.107-0.815), p=0.019] and LDAS [RR=0.383 (CI95%: 0.222-0.661), p=0.001] decrease the risk of Emergency Room visits. One hundred- thirty-five of the 165 hospitalizations presented a defined cause, being disease activity the most common cause of hospitalization with 73 admissions (54.1%); within them, renal disease was the leading cause, with 37 admissions (50.7%).

Conclusion:

Remission and LDAS decrease the risk of hospitalizations and Emergency Room visits in SLE patients. Disease activity was the most frequent cause of hospitalization and within them, renal disease. These findings have economic implications for the health care system.

Reference:

1. Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, Catoggio LJ, Drenkard C, Sarano J, et al. Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis.2017 Dec;76(12):2071-2074

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/remission-and-low-disease-activity-state-prevent-hospitalizations-and-emergency-room-visits-in-systemic-lupus-erythematosus-patients/