BackgroundInflammatory joint diseases (IJD) such as psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD) since inflammation plays a pivotal role in the pathogenesis of coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (Afib)1. Ischemic heart disease and HF are the main causes of the increased and premature mortality among patients with IJD2.Additionally, patients with PsA have a prevalence of hyperuricemia (HUC) of 32%, 3 times greater as compared with the general population, which may be related to increased cell turnover as well as the release of pro-inflammatory cytokines and tumor necrosis factor3.Prolonged exposure to high levels of uric acid (UA) has been shown to result in oxidative stress causing endothelial dysfunction, ionic channel changes, atrial and ventricular remodeling4. There is experimental evidence indicating that uric acid stimulates renin-angiotensin-aldosterone system (RAAS), and it is associated with an increase in cardiac tissue xanthine oxidase activity, all of which induce cardiomyocyte hypertrophy, myocardial oxidative stress, interstitial fibrosis and impaired diastolic relaxation5.ObjectivesThe aim of this study is to assess the correlation of HUC and the clinical expression of CVD in patients with PsA.MethodsThis is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults diagnosed with PsA based on ICD-10 codes, to detect the prevalence of cardiovascular (CV) conditions such as CAD, Afib, and HF with preserved ejection fraction (HFpEF) in patients with concomitant HUC or gout versus age matched controls. Chi square was used for point prevalence and multivariate linear regression adjusted for age, gender, race, CAD, diabetes mellitus, HTN, hyperlipidemia (HLD), smoking, chronic kidney disease (CKD) and Charlson comorbidity index for prevalence odds ratio (POR). We used STATA-15 for statistical analysis.ResultsWe identified 37,315 patients with PsA, of whom 2,165 had concomitant HUC or gout (5.80%). Mean age was 61 years, 57% were females. Our results showed that PsA with concomitant HUC or gout compared to PsA without HUC or gout was associated with a higher rate of Afib (17.8% vs 6.1%, p < 0.001), CAD (35.1% vs 19.4%, p < 0.001) and HFpEF (7.2% vs 3.1%, p < 0.001). Furthermore, patients with PsA and HUC/gout appeared to have more risk of developing Afib (POR 1.79; 95%-CI 1.31-2.45; p < 0.001) and HFpEF (POR 1.56; 95%-CI 1.08-2.26; p=0.018), compared to patients with normal uric acid after multivariate-adjustment for risk factors. No statistical difference in CAD was identified between the two groups (POR 1.21; 95%-CI 0.94-1.55; p=0.131) after multivariate linear regression adjustment for confounders.ConclusionThis study showed that HUC is independently associated with CVD, mainly with Afib and HFpEF in patients with PsA. It remains to be seen if a treat to target approach with normalization of UA in patients with PsA will result in improved CV outcomes. We believe that our findings merit further investig...

Aim:We investigated the association between systemic sclerosis (SSc) and perioperative cardiovascular risk for inpatient non-cardiac surgical procedures. Methods:We used data from the National Inpatient Sample (NIS) for the year 2014 to identify patients undergoing inpatient non-cardiac surgery. SSc and major adverse cardiovascular events (MACE) were defined by International Classification of Diseases 9th Revision diagnosis codes. Univariate and multivariate analyses were performed. We adjusted for demographic information, socioeconomic status, cardiac comorbidities, cardiovascular risk factors and procedural category. Two models were used with different categorization strategies for surgical procedures.Results: A total of 8 156 379 hospitalizations for non-cardiac surgeries were included, 4385 of which had a diagnosis of SSc. Patients with SSc were older, more likely to be female and Caucasian and with higher cardiac and systemic comorbidity burden. In univariate analysis, SSc was associated with higher risk of perioperative MACE (odds ratio [OR] = 2.9; P < 0.001) and all-cause death (P = 3.07; P < 0.001). Multivariate analysis yielded conflicting results regarding the association betweenSSc and perioperative MACE (Model 1: OR = 1.42; P = 0.146; Model 2: OR = 1.59; P = 0.048). Subsequent analysis showed that only perioperative myocardial infarction (Model 1 OR = 1.85; P = 0.048; Model 2 OR = 1.94; P = 0.031) was independently associated with SSc.

Background/Objective Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that often results in frequent hospitalizations. We investigated the characteristics and predictors of 30-day hospital readmissions in GPA. Methods We performed a cross-sectional analysis using the 2014 National Readmission Database. We included nonelective admissions with a primary or secondary diagnosis of GPA. We compared characteristics between readmissions and nonreadmissions. Independent predictors for readmissions were studied using mixed-effects multivariable logistic regression. Results We evaluated a total of 9749 hospital admissions with GPA, among which there were 2173 readmissions (22.3%) within 30 days of discharge. The top 5 primary reasons for readmissions were GPA, sepsis, pneumonia, acute respiratory failure, and acute kidney injury. Granulomatosis with polyangiitis readmissions were associated with higher length of stay (8.0 vs 7.2 days; p = 0.019) and less discharge home (50% vs 63%, p < 0.001). Independent predictors for readmissions were younger age (odds ratio [OR], 0.99; p = 0.013), no private insurance (OR, 0.50; p < 0.001), higher Charlson Comorbidity Index (OR, 1.12; p = 0.039), congestive heart failure (OR, 1.71; p = 0.001), acute kidney injury (OR, 1.39; p = 0.005), and discharge to home health care (OR, 1.29; p = 0.039). Conclusions We found a significant burden of 30-day readmissions among GPA populations. Clinicians should be vigilant regarding patients with high risk of readmissions, including those with younger age, public insurance, higher comorbidity burden, cardiac and renal complications, and unfavorable discharge dispositions.

BackgroundMultiple cases have been reported assessing the outcomes for solid-organ transplant recipients (SOTR) admitted to the hospital with septic arthritis of a native joint (SANJ); however, there are no data evaluating the outcome of these patients when they are admitted on the weekend compared with the rest of the week.MethodsThe NIS database of the year 2016 was utilized to identify all SOTR with SANJ using ICD-10 codes. SOTR status was defined as those adults with a history of a transplanted organ including heart, lungs, a combined heart and lung, liver, kidney, intestine or pancreas. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length o¬f stay and total hospital charges. These results were compared after univariable and multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis.ResultsWe identified 319 SOTR with SANJ. Compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased in-hospital mortality rates (odds ratio[OR] 11; 95% [CI] 1.2–97.9, P < 0.05), but similar, length of stay (P > 0.05) and hospital charges (P > 0.05). However, regardless of the day of admission those who received an early arthrocentesis had a lower length of stay (P < 0.05), and lower total hospital charges (P < 0.05).ConclusionOur study showed that compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had a significantly lower length of stay and hospital charges regardless of the day of admission. These results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.Disclosures All authors: No reported disclosures.

Background:Multiple studies have been done assessing the “weekend effect” and outcomes for hospitalized patients1,2,3,4, however, there is no data evaluating the outcome of patients with septic arthritis of a native joint (SANJ) who are admitted on the weekend compared to the rest of the week.Objectives:To evaluate whether important outcomes in SANJ, including in-hospital mortality, differ between patients admitted on weekends versus weekdays and the time to diagnostic arthrocentesis.Methods:The National Inpatient Sample (NIS) database of the year 2016 was utilized for patients admitted to the hospital with a principal discharge diagnosis of SANJ. This was a retrospective cohort study of patients hospitalized in 2016 with SANJ in hospitals across the US. Patients were included if they were adults with a principal diagnosis of SANJ based on ICD-10 codes. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. The proportion of patients with SANJ admitted over weekends versus weekdays was determined. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length of stay and total hospital charges, These results were compared after multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis.Results:The study included 12819 patients with SANJ. Compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased in-hospital mortality rates (adjusted odds ratio[aOR] 3.67; 95% [CI] 1.52 – 8.86, p<.005), but similar early arthrocentesis rates ([aOR] 1.14; 95%, [CI] 0.90 – 1.45 p>0.05), length of stay (p>0.05) and hospital charges ($ 2751.11; 95% [CI] -4449.6 – 9951.8; P>0.05). However, regardless of the day of admission those who received an early arthrocentesis had lower length of stay (-1.46, p<0.05), and lower total hospital charges ($ -6527 $; p<0.05).Conclusion:This study showed that compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had significantly lower length of stay and hospital charges regardless of the day of admission. This results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.References:[1] Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med2001;345:663-8.[2] Pauls LA, et al. The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J Hosp Med. 2017Sep;12(...