Background/Purpose: Libman-Sacks endocarditis characterized by thrombotic and/or non-infective sterile inflammatory vegetations are common in Systemic Lupus Erythematosus (SLE) and associated with increased morbidity. These vegetations can be complicated with superimposed infective endocarditis, embolic cerebrovascular disease, severe valvular regurgitation, and need for high-risk valve surgery. The study aims to compare the outcomes of SLE hospitalizations with and without Libman-Sacks endocarditis. The primary outcome was inpatient mortality, while secondary outcomes were hospital length of stay (LOS) and total hospital charges.

Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. This database is the largest collection of inpatient admission data in the USA. It is a nationally representative sample of 20% of hospitalizations from approximately 1,000 hospitals.  The numbers in the databases are weighted to optimize national estimates. The NIS was searched for SLE hospitalizations with Libman-Sacks endocarditis (“M32.11”) and SLE without endocarditis (remaining M32 ICD-10 codes) as principal or secondary diagnosis. SLE hospitalizations for adult patients (age≥ 18 years) from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for confounders for the primary and secondary outcomes respectively. Confounders adjusted for include age, sex, race, median income expected for zip code, Charleston comorbidity index, insurance status, and hospital location/region/teaching status and bed size. STATA software was used to analyze the data.

Results: There were combined 71 million discharges included in the 2016 and 2017 NIS database. 355,740 hospitalizations were for adult patients, who had either a principal or secondary ICD-10 code for SLE. 680 (0.19%) and 355,060 (99.81%) of these hospitalizations were for SLE with and without Libman-Sacks endocarditis respectively. The mean age for SLE with Libman-Sacks endocarditis was 43 vs 52 years without endocarditis (P< 0.001). 7,060 adult SLE hospitalizations (2%) resulted in inpatient mortality. 45 (6.6%) deaths occurred in SLE with Libman-Sacks endocarditis vs 7,015 (2%) without endocarditis (P=0.0001). The adjusted odds ratio (AOR) for inpatient mortality for SLE with Libman-Sacks endocarditis compared to those without endocarditis was 3.64 (95% CI 1.63-8.12, P=0.002). SLE with Libman-Sacks endocarditis hospitalizations had an increase in mean adjusted LOS of 5.22 days (95% CI 1.54-8.90, P=0.005) compared to SLE without endocarditis. Hospitalizations for SLE with Libman-Sacks endocarditis had an increase in mean adjusted total charges by $53,507 compared to SLE without endocarditis (95% CI 10,611-96,404, P=0.015).

Conclusion: Hospitalizations for SLE with Libman-Sacks endocarditis have more than 3 times the risk of in-hospital death compared to those without endocarditis. Hospitalizations for SLE with Libman-Sacks endocarditis have statistically and clinically significant increase in LOS and mean total hospital charges compared to those without endocarditis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematosus-with-libman-sacks-endocarditis-increases-inpatient-mortality/