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Abstract
Background/purpose Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalised patients particularly patients with autoimmune disorders. Nationwide Inpatient Sample (NIS) database was analysed to determine trends in rate of hospitalisation and mortality from VTE in hospitalised systemic lupus erythematosus (SLE) patients to assess its impact.
Methods 2003–2011 NIS database of Healthcare Cost and Utilisation Project was queried to identify all adults (age >18 years) hospitalised with SLE and VTE. Demographic characteristics and in-hospital outcomes of this population were compared to SLE patients without a VTE diagnosis. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR).
Results The total number of hospitalised patients with SLE was 2 99 595 of which 9175 (3.06%) had VTE. Mean age of the study population was 50 years and 89% were females. Mean age of SLE patients with VTE was lower than those without VTE (48 vs 51 years). Rate of VTE was higher in African Americans as compared to Caucasians (3.8% vs 2.8%) and in males when compared to females (4.3% vs 2.9%).
After adjusting for potential confounders, compared to those without VTE, SLE patients with VTE had higher inpatient mortality (5% vs 2.0%, OR 2.35 (CI: 2.10 to 2.62, p<0.001), greater disability at discharge (34% vs 26%, OR 1.53 (CI: 1.46 to 1.62), p<0.001), longer length of stay by 3.57 days and higher cost of hospitalisation by $24 500 (table 1).
The rate of VTE among SLE patients have increased since 2005 as shown in Graph 1.
Conclusion VTE in hospitalised patients with SLE is associated with significantly higher inpatient mortality, greater disability at discharge, increased length of stay and higher cost of hospitalisation. The rate of VTE in SLE patients is on rise likely due to awareness and higher reporting. In this database patients with SLE and VTE were younger. Male sex and African-American race may be associated with an increased risk of VTE in patients with SLE. This cross-sectional study would help in the development and implementation of appropriate prophylactic strategies in high risk SLE population.
Outcomes