Background All patients with SLE residing in the county of Funen are offered specialized care in a dedicated lupus outpatient clinic at 1-4 months intervals as needed. The pattern and frequency of hospitalizations in this setting has not been studied in detail. Previously, the rate of hospitalizations among patients attending a US specialist lupus clinic in 1989-1990 amounted to 56.3 % with active SLE as the major cause of admission (1).
Objectives To determine the incidence and cause of hospitalizations in a population-based cohort of SLE patients.
Methods In 1995 a population-derived cohort of patients with SLE according to the 1982/1997 ACR criteria was established. Subsequently, incident and immigrant patients have been included consecutively while emigrating and deceased individuals have been accounted for. During January 2007 through September 2012 all hospitalizations among 155 lupus patients were investigated based on information in a research database and medical files. Disease activity (SLEDAI-2K) upon admission and damage according to the SLICC/ACR damage index (SDI) by the end of the study period were recorded as well as duration of hospitalization and cause of admission. Results are reported as medians (range) and means (standard deviation). Medians are compared using the Mann Whitney test and proportions with chi-square test.
Results A total of 101 patients (65.2 %) experienced one or more hospitalizations during the observation period amounting to a total of 446 admissions, median 2 (1-28) per patient. 0.9 % of admissions ended in death. Admissions were more frequent among males than females, 4 (1-28) vs 2 (1-27), P = 0.02. The overall incidence of hospitalizations was 0.50 admission/person-year. Mean duration was 6.4 (10.5) and median 2 (0-76) days. In the background population the incidence of hospitalizations was 0.25 admission/person-year and the mean duration was 4.1 days. Mean SLEDAI score at admission was 5.1 (5.8), median 4 (0-31) with a tendency towards longer stays with higher scores. Permanent organ damage evolved in 8.5 % of admissions. Patients hospitalized had significantly higher accumulated damage (SDI) compared to those not admitted, median 2 (0-11) vs 1 (0-5), P = 0.02. The duration of admission was longer in patients with low serum albumin than those with normal levels, 9 (0-76) vs 6 (0-29) days, P = 0.003. Hospitalized patients tended to be younger than those not admitted, median 43 (15-76) vs 49 (14-88), P = 0.08, and more frequently suffer from antiphospholipid syndrome, APS, 37 % vs 12 %, P = 0.07. The main causes of hospitalization were: Complications to SLE or its treatment (31 %), infections (22 %), SLE disease activity (15 %), “other” including obstetric, or surgical causes (32%).
Conclusions Despite careful clinical and serological follow-up the present, unselected lupus cohort of predominantly Caucasian origin experienced an excess number of hospital admissions compared to the background population. However, the need for in-patient management was unevenly distributed, primarily occurring in those 2/3 of the cohort accumulating damage. Male patients had significantly more admissions compared with female patients. Most admissions were related to SLE and/or its treatment and infections.
Petri M. J Rheumat 1992;19:1559-65.
Acknowledgements AV received grants from The Danish Rheumatism Association (Grant R33-A1836), The AP Møller Foundation and The Region of Southern Denmark.
Disclosure of Interest: None Declared
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