A Population‐Based Study of Infection‐Related Hospital Mortality in Patients With Dermatomyositis/Polymyositis

Murray, Sara G.; Schmajuk, Gabriela; Trupin, Laura; Lawson, Erica; Cascino, Matthew D.; Barton, Jennifer L.; Margaretten, Mary; Katz, Patricia P.; Yelin, Edward H.; Yazdany, Jinoos

doi:10.1002/acr.22501

Cited by 44 publications

(37 citation statements)

References 26 publications

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“…In the following intragroup analysis, bacterial infection was found to be associated with unfavorable short-term outcome in DM, PM, or CADM patients complicated with AE-ILD. Similar linkage between infection and short-term outcome was seen in IIM patients (3,4). And opportunistic infection was as well-recognized as a major cause of mortality in patients with IIM-related ILD (48).…”

Section: Discussionmentioning

confidence: 57%

“…Although the incidence of DM, PM, and CADM was considerably low in common people, the high mortality rate, the various clinical manifestations, and multiple complications have drawn much attention from clinicians and researchers. In published studies, the 10-year survival rate for patients with DM, PM, or CADM ranged from 51 to 91% (3). An ∼4.5% in-hospital mortality rate was seen in two retrospective studies (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…In published studies, the 10-year survival rate for patients with DM, PM, or CADM ranged from 51 to 91% (3). An ∼4.5% in-hospital mortality rate was seen in two retrospective studies (3,4).…”

Section: Introductionmentioning

confidence: 99%

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Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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This study aimed at clarifying the prevalence, risk factors, outcome, and outcome-related factors of acute exacerbation of interstitial lung disease (AE-ILD) in patients with idiopathic inflammatory myopathy (IIM). Methods: Data of IIM patients who were admitted to the First Affiliated Hospital of Zhejiang University (FAHZJU) from September 2007 to September 2019 were retrospectively collected. And the IIM patients with AE-ILD formed the case group. In addition, age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. A 1:2 case-control study and intragroup analysis were performed to identify risk factors for development of AE-ILD in IIM patients and unfavorable short-term outcome in AE-ILD patients through comparison, univariate and multivariate logistic regression analysis. Results: AE-ILD occurred in 64 out of 665 IIM patients (9.6%) with a short-term mortality rate of 39.1%. And the 64 IIM patients with AE-ILD formed the case group. Besides, 128 age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. The retrospective case-control study revealed that elevated on-admission disease activity (P < 0.001), lower percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.013) and diagnosis of clinically amyopathic dermatomyositis (CADM, P = 0.007) were risk factors for development of AE-ILD in IIM patients. The following intragroup analysis indicated that elevated on-admission disease activity (P = 0.008) and bacterial infection (P = 0.003) were significantly correlated with the unfavorable short-term outcome of patients complicated with AE-ILD. In addition, combined use of steroid and disease modifying antirheumatic drugs (DMARDs, P = 0.006) was found to significantly reduce the short-term mortality in IIM patients with AE-ILD. Conclusion: AE-ILD is a less frequent but fatal complication in IIM patients with elevated on-admission disease activity, lower DLCO% and diagnosis of CADM working as risk factors, indicating the potential roles of autoimmune abnormality and hypoxia in development of AE-ILD. Elevated on-admission disease activity and bacterial infection could predict unfavorable short-term outcome of IIM patients with AE-ILD. A therapeutic regimen of steroid and DMARDs was found to reduce short-term death in these patients.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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“…This is a validated measure that enables prediction of 1‐year mortality based on composite comorbid conditions . We created a modified CCI for our multivariable analysis by removing CVD variables so that CVD could be analyzed as an independent variable . AS is not included in the CCI.…”

Section: Methodsmentioning

confidence: 99%

Cervical Spinal Fracture and Other Diagnoses Associated With Mortality in Hospitalized Ankylosing Spondylitis Patients

Wysham

Murray

Hills

et al. 2017

Arthritis Care & Research

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Objective Little data exist regarding mortality in Ankylosing Spondylitis (AS). We assessed diagnoses associated with in-hospital mortality in AS using a population-based inpatient dataset. Methods Data were abstracted from the Healthcare Cost and Utilization Project- Nationwide Inpatient Sample (HCUP-NIS) between 2007–2011. We identified AS admissions using International Classification of Diseases-9 Clinical Modification (ICD9-CM) code 720.0. In-hospital mortality was the primary outcome. Logistic regression was used to evaluate the association between top diagnoses and in-hospital mortality. We performed a secondary analysis from the same years in all patients (with and without AS) with cervical spine (c-spine) fracture to determine whether AS was an independent risk factor for mortality. Results Between 2007–2011 we identified 12,484 admissions and 267 deaths in AS patients. C-spine fracture with spinal cord injury and sepsis had the highest odds (OR) of death, 13.43 (95% Confidence Interval (CI) 8.00–22.55; p<0.0001) and 7.63 (95% CI 5.62–10.36; p<0.0001) respectively. In the same time period, there were 53,606 C-spine fracture admissions of which 408 were coded with AS. Among all c-spine fracture hospitalizations, an AS diagnosis was associated with in-patient death (OR 1.61; 95% CI 1.16–2.22; p=0.004). Conclusion In AS patients admitted to the hospital, c-spine fracture is a leading cause of in-hospital mortality. Other diagnoses associated with mortality include sepsis, pneumonia, CVD and comorbid illnesses. Among all hospitalizations with c-spine fracture, AS was associated with an increased odds of death. C-spine fracture-associated mortality warrants further study to elucidate risk factors in order to prevent this devastating event in AS patients.

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“…For patients with anti-MDA5 positive, once RP-ILD occurs, the mortality is as high as over 70% [6]. Besides, pneumonia occurred 18.3% in patients with IIM in a population-based study, and infections brought the leading cause of hospital mortality of the patients [7]. Both RP-ILD and pneumonia could cause acute respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

Wang

Zhang

Ren

et al. 2020

Preprint

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Background: This study aims to identify prognostic factors for mortality of patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5) or anti-aminoacyl-RNA synthetase (anti-ARS) antibodies positive and acute respiratory failure in the intensive care unit.Methods: Clinical characteristics, laboratory test findings, imaging performance, and management were retrospectively collected in all cases with anti-MDA5 and anti-ARS antibodies positive, as well as follow-up survival data. Risk factors related to prognosis were identified by Cox regression analysis.Results: The 28-day mortality of all patients was 68.8% (n=44/64). The patients who died were more likely to have anti-MDA5 antibody(p<0.001), presented more Gottron papules(p=0.021) or heliotrope rash(p=0.008), had a relatively lower level of WBC(p=0.038), CRP(p=0.004), and had a higher level of LDH(p=0.029), serum ferritin(p=0.002). The main risk factors associated with 28-day mortality were anti-MDA5 antibody positive [HR 10.827 (95% CI: 4.261-27.514), p<0.001], presence of Gottron papules [2.299 (1.203-4.394), p=0.012], heliotrope rash [3.423 (1.773-6.606), p<0.001], and arthritis/arthralgia [2.365 (1.130-4.948), p=0.022). At a median of 14 (IQR 6.33-35.0) months of follow-up, the overall mortality of all patients was 75.0% (n=48/64). The non-survivors were more likely to own anti-MDA5 antibody(p<0.001), had a higher rate of Gottron papules(p=0.020) or heliotrope rash(p=0.014), had lower PFR(p=0.032) while ICU admission, and existed a higher level of serum ferritin(p=0.005). Main risk factors associated with overall mortality were consistent with risk factors for 28-day mortality. Conclusions: Anti-MDA5 antibody positive, presence of Gottron papules, heliotrope rash, or arthritis/arthralgia were the main independent risk factors of poor prognosis for IIM patients admitted to the ICU due to acute respiratory failure.

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A Population‐Based Study of Infection‐Related Hospital Mortality in Patients With Dermatomyositis/Polymyositis

Cited by 44 publications

References 26 publications

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Cervical Spinal Fracture and Other Diagnoses Associated With Mortality in Hospitalized Ankylosing Spondylitis Patients

Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

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