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Epidemiology and outcomes
Immunosuppressant use and hospitalisations in adult patients with systemic lupus erythematosus admitted to a tertiary academic medical centre
  1. Christine Anastasiou1,2,
  2. Olivia Dulai3,4,
  3. Amrutha Baskaran1,
  4. James Proudfoot5,
  5. Samuel Verhaegen6 and
  6. Kenneth Kalunian1
  1. 1 Department of Medicine, University of California San Diego, San Diego, California, USA
  2. 2 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Medicine, University of California Medical Center, La Jolla, California, USA
  4. 4 Chadwick School, Palos Verdes Peninsula, California, USA
  5. 5 Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA
  6. 6 Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Professor Kenneth Kalunian; kkalunian{at}ucsd.edu

Abstract

Objectives To describe how immunosuppressant use and hospitalisation patterns for SLE have evolved by comparing admission statistics at one academic centre between 2005 and 2013.

Methods We identified admissions for SLE and for all hospitalised patients by using the hospital electronic database. For adult patients with SLE, a comprehensive chart review was conducted to identify primary indications for hospitalisation, in-hospital mortality, mean length of stay and immunosuppressant use.

Results The number of yearly SLE patient hospitalisations decreased from 178 to 86 between the two times of observation. Infection was the most common reason for hospitalisation accounting for 39.9% of hospitalisations in 2005 versus 31.4% of hospitalisations in 2013 (p=0.29). Lupus flare accounted for 9.6% of admissions in 2005 versus 8.1% of admissions in 2013 (p=0.72). Seven patients died during their hospitalisation (3.9% of admissions) in 2005 as opposed to no inpatient deaths in 2013. Of the 261 admissions between 2010 and 2013, six admissions resulted in death (2.3% of admissions). SLE patient mean length of hospital stay decreased from 7.6 days to 6.4 days (p=0.36) compared with all patient length of stay, which decreased from 6 days to 5.8 days. Corticosteroid use decreased (79.8% to 61.6%, p=0.11) while hydroxychloroquine (27.0% to 59.3%, p<0.001) use increased over time.

Conclusions The number of hospitalisations, mortality and length of stay among hospitalised patients with SLE decreased over time. Infection was the primary reason for inpatient hospitalisation. Hydroxychloroquine use more than doubled over this same time period with statistical significance. These pilot data suggest improvements in SLE hospitalisation outcomes over time, but larger studies are needed to examine these trends and to understand the relationship between changing medication prescribing patterns and hospitalisation outcomes in patients with SLE.

  • systemic lupus erythematosus
  • corticosteroids
  • dmards (synthetic)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2017-000249

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    Footnotes

    • Contributors Study design: AB, CA, KK. Acquisition of data: CA, OD,AB, KK. Analysis and interpretation of data: CA, OD, KK. Manuscript preparation: CA, OD, JP, KK. Statistical analysis: JP, SV, CA, KK.

    • Funding William Wolfe Research Fund, University of California San Diego.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was reviewed and approved by the University of California San Diego Institutional Review Board under Project number 140746. A waiver of individual authorisation for the use of Protected Health Information (PHI) was granted based on HIPAA Privacy Rule 45 CFR 164 section 512 (I) and the research satisfying the following criteria: the use or disclosure of PHI involves no more than minimal risk; granting of waiver will not adversely affect privacy rights and welfare of the individuals whose records will be used; the project could not practicably be conducted without a waiver; the project could not practicably be conducted without the use of PHI; the privacy risks are reasonable related to the anticipated benefits of research; an adequate plan to protect identifiers from improper use and disclosure is included in the research proposal; an adequate plan to destroy identifiers at the earliest opportunity, or justification for retaining identifiers, is included in the research plan; the project plan includes written assurances that PHI will not be re-used or disclosed for other purposes.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.