Characteristics of comorbidities and costs among patients who died from systemic lupus erythematosus in Taiwan

Abstract

IntroductionSystemic lupus erythematosus (SLE) is prevalent among young female adults, particularly in Asia. In Taiwan, features of end-of-life SLE patients remain unclear.Material and methodsData regarding SLE patients whose hospitalization ended up with death were collected and analyzed from the repository of the National Health Insurance Research Database, Taiwan, from 2005 to 2007.ResultsA total of 302 subjects were enrolled and the majority of these were young to middle-aged women (45.8 ±18.5 years); only one third of them were treated by rheumatologists. Eight patients (2.6%) with comorbid cancers received hospice care. Sepsis/bacteremia (42.1%) was the major acute comorbidity. Nephropathy/nephritis (35.1%) represented the major chronic comorbidity. Among 27 subjects with comorbid cancers, gynecological cancers were the most common (18%). Among the inpatient costs, the cost of prescriptions accounted for the majority (21.7 ±11.5%). Under a multivariate logistic regression, advanced age (≥ 65 years) correlated positively with acute lower respiratory conditions (ALRC) and diabetes mellitus (DM), and male gender correlated negatively with nephropathy/nephritis. The nephropathy/nephritis correlated positively with hospital stays > 14 days. The ALRC was closely associated with acute respiratory failure, but not with shock. However, shock was closely associated with hospital stays ≥ 14 days and sepsis/bacteremia. Cancer development was inversely correlated to nephropathy/nephritis, acute respiratory failure, and shock (all p < 0.05).ConclusionsThe end-of-life SLE patients revealed aforementioned characteristics and relationships. Sepsis/bacteremia, acute respiratory failure, and ALRC contributed most frequently to the ultimate death of acutely ill SLE patients.

The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital

“…28,31,40,41 In line with these results, we found that the risk of mortality in SLE patients with infectious disease was more than double after adjustment for all the demographic and clinical characteristics. In a retrospective study of 223 SLE patients, Edwards et al also reported that presence of infection was one of the main predictors for mortality (odds ratio (OR) 7.3, p < 0.01).…”

Integrated analysis of lncRNA, miRNA and mRNA expression profiling in patients with systemic lupus erythematosus

“…Systemic lupus erythematosus (SLE), a kind of severe autoimmune disease (AID), is characterized by loss of immunological tolerance to self-nuclear antigens, abnormal T- and B-cell responses and autoantibody production [1, 2]. To date, the pathogenesis of SLE remains uncertain [3].…”

Kepatuhan Minum Obat Pada Pasien Lupus Eritematosus Sistemik Di RSUP Dr. Hasan Sadikin Bandung

“…Kepatuhan minum obat pada lupus eritematosus sistemik (LES) sebagai penyakit kronik yang belum diketahui penyebabnya, serta diperberat dengan berbagai comorbidities, masih menjadi perhatian karena berpengaruh pada perjalanan penyakit dan biaya yang ditimbulkan. 1,2 Orang dengan lupus (odapus) harus mengonsumsi berbagai jenis obat seumur hidupnya yang bertujuan meningkatkan kualitas hidup. Dipihak lain pengobatan tersebut dapat menimbulkan efek samping serius yang dapat memperburuk kondisi kesehatan odapus.…”

“…3 Keadaan tersebut yang menyebabkan ketidakpatuhan minum obat pada penyandang LES, seperti halnya terjadi di Selandia Baru (46%); Brasil (20%); dan Mesir (38%). 1,4,5 Ketidakpatuhan pada LES menyebabkan peningkatan angka kunjungan ke unit gawat darurat dan juga rawat inap, dengan dampak peningkatan beban fisik, psikis, sosial serta ekonomi yang harus ditanggung oleh odapus dan keluarganya. 6 Mengingat dampak yang cukup penting, maka perlu dilakukan strategi pencegahan dan intervensi untuk mengatasi ketidakpatuhan pada LES.…”