Immunosuppressant use and hospitalisations in adult patients with systemic lupus erythematosus admitted to a tertiary academic medical centre

Abstract

ObjectivesTo describe how immunosuppressant use and hospitalisation patterns for SLE have evolved by comparing admission statistics at one academic centre between 2005 and 2013.MethodsWe identified admissions for SLE and for all hospitalised patients by using the hospital electronic database. For adult patients with SLE, a comprehensive chart review was conducted to identify primary indications for hospitalisation, in-hospital mortality, mean length of stay and immunosuppressant use.ResultsThe number of yearly SLE patient hospitalisations decreased from 178 to 86 between the two times of observation. Infection was the most common reason for hospitalisation accounting for 39.9% of hospitalisations in 2005 versus 31.4% of hospitalisations in 2013 (p=0.29). Lupus flare accounted for 9.6% of admissions in 2005 versus 8.1% of admissions in 2013 (p=0.72). Seven patients died during their hospitalisation (3.9% of admissions) in 2005 as opposed to no inpatient deaths in 2013. Of the 261 admissions between 2010 and 2013, six admissions resulted in death (2.3% of admissions). SLE patient mean length of hospital stay decreased from 7.6 days to 6.4 days (p=0.36) compared with all patient length of stay, which decreased from 6 days to 5.8 days. Corticosteroid use decreased (79.8% to 61.6%, p=0.11) while hydroxychloroquine (27.0% to 59.3%, p<0.001) use increased over time.ConclusionsThe number of hospitalisations, mortality and length of stay among hospitalised patients with SLE decreased over time. Infection was the primary reason for inpatient hospitalisation. Hydroxychloroquine use more than doubled over this same time period with statistical significance. These pilot data suggest improvements in SLE hospitalisation outcomes over time, but larger studies are needed to examine these trends and to understand the relationship between changing medication prescribing patterns and hospitalisation outcomes in patients with SLE.

One-decade study of distinct features, morbidity and mortality of systemic lupus erythematosus (an update on systemic lupus erythematosus in the Fars Province of Iran)

“…Nevertheless, further studies by this group in 2013 reported that infection and cardiac involvement were the most common etiologies of hospital admissions. 34 Another study by Jorda´n-Gonza´lez et al also declared that infection was the most common cause of hospital admission. 35 These contrasts between our results and other studies may relate to genetic background, various major organ involvement and different types of immunosuppressive therapy applied for the disease.…”

Clinical Profile and Incidence of Infection in Systemic Lupus Erythematosus Patients at Medical Inpatient Installation, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016

“…Immunosuppressant therapy which decreases the immune system makes the body vulnerable to infection. Low use of corticosteroids shows a relationship to decreased incidence of infection in SLE patients in United States, although this result should be evaluated thoroughly (Anastasiou, et al, 2018).…”

Bacterial infections in lupus: Roles in promoting immune activation and in pathogenesis of the disease

“…In addition to this greater prevalence of hospitalization, high rates of serious infection contribute significantly to increased mortality as compared to the general populace [ 17 , 32 , [88] , [89] , [90] , [91] , [92] ]. Bacterial pathogens have been identified as a major contributor to infection in SLE patients, comprising 60–75% of all infections reported [ 17 , 26 , 27 , [29] , [30] , [31] , [32] , [33] , [34] , 90 , [93] , [94] , [95] , [96] ]. The risk of opportunistic infection, including bacterial infections, is elevated in SLE patients compared to the general populace [ 97 ].…”

“…These physical manifestations and the resulting end stage organ failures are common causes of death for SLE patients. However, studies over time have also identified infection as a major cause for hospitalization and mortality ( Table 1 ) [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. For instance, of 1000 European SLE patients followed prospectively over a 5-year period, 27% developed infections and among those that died during the study period, 29% died from infection [ 26 ].…”