Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Individuals with systemic lupus erythematosus (SLE) are at increased risk for venous thromboembolism (VTE). However, there is limited population-based data on outcomes associated with VTE in patients with SLE. The aims of our study were to determine 1) the prevalence of VTE among hospitalizations for SLE, and 2) the independent effect of VTE on hospital outcomes in SLE, including length of stay and in-hospital mortality.
Methods: Using data from the Health Care Cost and Utilization Project State Inpatient Databases, we performed a retrospective study of hospitalizations among adult patients with a diagnosis of SLE in five geographically dispersed states in 2009. Individuals with VTE were identified using validated administrative definitions of deep vein thrombosis (DVT) and pulmonary embolism (PE). We used multivariable regression analyses to examine the effect of VTE on length of stay and in-hospital mortality, the primary outcomes in our analysis. We adjusted for sociodemographic characteristics (age, sex, race/ethnicity), median household income based on zip code, modified Charlson comorbidity index, and a SLE-specific risk adjustment index for in-hospital mortality developed by Ward. In additional analyses, we examined the effect of DVT and PE separately.
Results: A total of 41,806 hospitalizations for patients with SLE were identified. 1,543 of these hospitalizations (3.7%) were associated with VTE; 1,063 patients had DVT (2.5%), 352 patients had PE (0.84%), and 128 (0.31%) had both. VTE patients were younger (48.1 years vs. 51.0 years, p<0.001), more likely to be black race (31.9% vs. 24.2%, p>0.001), more likely to have Medicaid as the primary payer (24.0% vs. 20.1%, p<0.001), had higher SLE-specific risk adjustment index (2.64 vs. 2.44, p=0.005), and were more likely to have nephritis (25.4% vs. 19.2%, p<0.001), hemolytic anemia (1.75% vs. 0.78%, p<0.001), thrombocytopenia (5.06% vs. 3.69%, p<0.001), and pleuritis (5.38% vs. 3.43%, p<0.001). In unadjusted analysis, VTE was associated with longer length of stay (9.8 vs. 5.8 days, p<0.001) and increased in-hospital mortality (4.0% vs. 2.0%, p<0.001). Results of adjusted analyses are depicted in the Table and demonstrate that VTE, DVT, and PE are independently associated with increased length of stay and in-hospital mortality.
Conclusion: The development of VTE was associated with a significant increase in length of stay and in-hospital mortality among a representative population of hospitalized SLE patients.
Table. Adjusted regression analyses of VTE, DVT, and PE with length of stay and in-hospital mortality.
|
|
|
Length of stay |
Mortality |
||
|
|
N (%) |
B coeff. (95% C.I.) |
p-value |
OR (95% C.I.) |
p-value |
|
VTE |
1,543 (3.69%) |
3.84 (3.43-4.25) |
<0.001 |
2.00 (1.50-2.65) |
<0.001 |
|
PE |
480 (1.15%) |
2.95 (2.23-3.67) |
<0.001 |
2.42 (1.52-3.85) |
<0.001 |
|
DVT |
1,063 (2.54%) |
4.24 (3.75-4.73) |
<0.001 |
1.81 (1.28-2.58) |
0.001 |
Adjusted for age, gender, race/ethnicity, median household income by zip code, primary payer, Charlson comorbidity index, and a SLE-specific risk adjustment index developed by Ward.
Separate analyses were performed to identify the individual effects of PE and DVT. Patients with both PE and DVT were classified as having PE for this analysis.
Disclosure:
M. Cascino,
None;
L. Trupin,
None;
S. Murray,
None;
M. Margaretten,
None;
E. H. Yelin,
None;
J. Yazdany,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/venous-thromboembolic-disease-is-associated-with-increased-length-of-stay-and-in-hospital-mortality-in-hospitalized-sle-patients-a-multi-state-population-based-study/