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

Abstract

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.

An Analysis of Patient and Fracture Characteristics and Clinical Outcomes in Patients With Hyperostotic Spine Fractures

“…Similarly, previous work using the Nationwide Inpatient Sample by Wysham et al found that patients with cervical spine fractures in the setting of AS had a significantly higher mortality rate. 18 In another study utilizing Nationwide Inpatient Sample, Kurucan et al found a significant association between cervical spine fractures managed operatively in patients with AS and pulmonary complications. 19 However, in the multivariable logistic regression analysis, we found that patients with a thoracic spine fracture in the setting of AS or DISH had decreased odds of having a complication or dying from the event within 1 year; the other spine regions did not show such an association.…”

Association of Congestive Heart Failure and Death with Ankylosing Spondylitis : A Nationwide Longitudinal Cohort Study in Korea

“…Several studies have reported death in AS patients [ 26 , 33 ], and there are controversies whether AS increases the death rate. A report showed that AS does not have an effect on death [ 6 ].…”

Langfassung zur S3-Leitlinie Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen, Update 2019

“…Bei Patienten mit SpA können Komorbiditäten vorliegen und sollten regelmäßig diagnostiziert und therapiert werden. In der internationalen COMOSPA-Studie zur Erfassung von Komorbiditäten und ihrer Screeningstrategie bei Patienten mit SpA waren die häufigsten Komorbiditäten Osteoporose (13 %), gastrointestinale Ulzerationen (11 %) und kardiovaskuläre Erkrankungen [161].…”