Objectives To evaluate hospital admissions in SLE patients through a retrospective population-based study analyzing hospitalization data during 2001-2012 in Sardinia, an Italian region with universal Health System coverage.
Methods Data on the hospital discharge records with ICD-9-CM diagnosis code of SLE (710.0), related to the hospitalization of patients resident in Sardinia in 2001-2012, were obtained from the Department of Health and Hygiene. Hospitalizations were retrospectively analyzed according to sex, age, types of admission (in-patient or day-hospital) and DRG code. The overall number of hospitalizations was determined for each year differentiating between those reporting the SLE code 710.0 as the primary and non-primary discharge diagnosis. In order to establish the significance of the annual trend for number and type of primary and non-primary discharge diagnosis, the two-tailed Cochran-Armitage test for trend was applied; p values <0.01 were considered significant.
Results This study included 6,222 hospitalizations in 1,675 patients (87% women); 45.0% of hospitalizations occurred in patients aged 25-44 years and 29.9% in those aged 45-64 years. Stratification for admission type revealed that 67.6% were in-patient and 32.2% were day-hospital (a one-day programmed hospitalization).
Hospitalizations with SLE as primary diagnosis were 3,782 (58.0%). While overall admissions with any discharge diagnosis in the regional area showed a 25.6% decrease in the study period, the hospitalizations with SLE as the primary diagnosis significantly (p<0.0001) fell by 47.0%; hospitalizations with SLE as non-primary diagnosis remained almost stable. When the non-primary diagnoses associated with SLE as primary diagnosis were analysed, renal disorders accounted for 681 admissions (18.0%), hematological abnormalities for 510 (13.5%), neuropsychiatric disorders for 325 (8.6%) and bone fragility fractures secondary to osteoporosis for 49 (1.3%). The annual number of renal, hematologic and neuropsychiatric disorders remained constant; however, their percentage raised (p<0.0001) because of a declined number of admissions for SLE without associated diagnosis and without complications (DRG code 241).
Analyzing hospitalizations with SLE as non-primary diagnosis revealed that infections accounted for 184 admissions (7.5%), chronic renal failure (CRF) for 156 (6.4%), malignancies for 87 (3.6%), complication of pregnancy, labor and childbirth for 82 (3.4%), cerebrovascular accident (CVA) for 53 (2.2%), acute coronary syndrome (ACS) for 43 (1.8%) and adverse drug reaction (ADR) for 36 (1.5%). CVA, ACS and CRF showed a significant (p<0.001) upward trend in number and percentage, while complications of pregnancy, labor and childbirth, malignancies and ADR did not show statistically significant changes. Infections showed an increasing trend, but did not reach statistical significance (p=0.0304).
Conclusions While overall hospitalizations for SLE patients declined, those for CVA, ACS and CRF as underlying primary diagnosis associated with SLE increased during the study period.
Disclosure of Interest None declared