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420 Hospitalisation for comorbid conditions in patients with systemic lupus erythematosus is more frequently due to cardiovascular and renal complications, subsequently increasing the risk of death
  1. W Raymond1,
  2. D Preen2,
  3. C Inderjeeth3,
  4. H Keen4 and
  5. J Nossent1
  1. 1The University of Western Australia, Rheumatology Group – School of Medicine, Perth, Australia
  2. 2The University of Western Australia, School of Population Health, Perth, Australia
  3. 3Sir Charles Gairdner and Osborne Park Hospital Group, Rheumatology, Perth, Australia
  4. 4Fiona Stanley Hospital, Rheumatology, Perth, Australia

Abstract

Background and aims Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that runs an unpredictable disease course. We aimed to understand the characteristics and outcomes of incident hospitalisation for conditions other than the underlying disease in SLE patients.

Methods Using whole-population data linkage of hospital admissions and death records in Western Australia (WA) WA between 1980 and 2015, we performed a retrospective analysis for patients where SLE (ICD-9-CM 695.4, 710.0 and ICD-10-AM L93.0 and M32) was a co-existing discharge diagnosis. All SLE patients were age- and gender-matched with hospital controls free of rheumatic disease. We investigated the rate and characteristics of the index hospitalisation for comorbidity and the risk of subsequent death by Kaplan-Meier survival and Cox regression.

Results Hospitalisation rates for comorbidity were 13.9/million/year in SLE patients. SLE patients were similar to controls for age and gender, but more likely to be Indigenous, have renal failure, cardiovascular and thrombotic conditions (Table 1). Independent predictors of mortality risk following hospitalisation for a comorbid condition included: SLE diagnosis (OR 1.6, CI: 1.3–1.9, p<0.001) (Figure 1), cerebrovascular events (OR 2.0, CI: 1.2–3.7, p<0.001), renal disease (OR 1.75, CI: 1.4–2.3 p<0.001), thrombotic events (OR 1.8 CI: 1.1–2.8, p=0.001) and reliance on Medicare (OR 1.5, CI: 1.3–1.8, p<0.001) (Table 2).

Abstract 420 Table 1

Patient Characteristics (at index hospitalisation) and study outcomes.

Abstract 420 Figure 1

Kalpan-Meier suvival analysis of mortality outcomes for SLE patients and age- & sex-matched controls (free of rheumatic disease conditions) from index hospitalisation (Log Rank (Mantel-Cox) χ2158.265, p<0.001).

Abstract 420 Table 2

Cox Regression analysis for all-cause mortality.

Conclusions SLE patients were more frequently hospitalised than controls for cardiovascular or renal conditions and this increased their mortality risk. These results strengthen the need for close monitoring and interventions to prevent such comorbidity in all SLE patients.

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