{"title":"Mortality among inpatients with systemic lupus erythematosus in a tertiary care hospital.","authors":"Mohan Kumar Hanumanthappa, Manisha Gulia, Vikas Sharma, Navneet Arora, Godasi Srsnk Naidu, Valliappan Muthu, Vishal Sharma, Varun Dhir, Manish Rathi, Harbir Singh Kohli, Sanjay Jain, Aman Sharma","doi":"10.1177/09612033251360287","DOIUrl":null,"url":null,"abstract":"<p><p>BackgroundSystemic lupus erythematosus (SLE) is associated with significant morbidity and mortality, particularly during hospitalisation. Differentiating between infection and disease activity is crucial but challenging. Regional variations in infection rates and disease manifestations necessitate region-specific studies.ObjectivesTo evaluate whether infections at or during hospitalisation are associated with increased mortality among SLE patients and identify additional predictors of adverse outcomes.MethodsThis retrospective case-control study included SLE patients hospitalised between January 2012 and December 2021. Cases (<i>n</i> = 111) were patients who expired during hospitalisation, matched 1:2 with controls (<i>n</i> = 222) discharged alive, based on age (±3 years) and sex, stratified annually. SLE diagnosis was based on ACR 1997 or SLICC 2012 criteria. COVID-19 cases were excluded. Patients were categorised by admission cause as 'Infection', 'Disease-associated', or 'Mixed'. Data on demographics, clinical features, laboratory parameters, and treatments were extracted, and multivariable logistic regression identified independent predictors of mortality.ResultsThe hospital mortality rate was 8.9%. Infection (with or without disease activity) significantly contributed to hospital admissions among non-survivors (57%) compared to survivors (25%; <i>p</i> < 0.001). Acinetobacter baumannii was the most frequent pathogen. Multivariable analysis showed infection at hospitalisation (OR 3.37, 95% CI 1.85-6.13), pulmonary involvement (OR 3.06, 95% CI 1.52-6.18), cardiac involvement (OR 2.13, 95% CI 1.07-4.25), and serum creatinine levels as independent predictors of mortality. Higher serum albumin was protective (OR 0.53, 95% CI 0.35-0.79). Juvenile lupus subgroup analysis (<i>n</i> = 38) revealed similar infection-related mortality patterns.ConclusionsOur study highlights the significant impact of infections, particularly hospital-acquired infections, on mortality among hospitalised SLE patients. Enhanced clinical vigilance, early interventions, and rigorous infection control measures are needed to improve outcomes in hospitalised SLE patients.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1080-1087"},"PeriodicalIF":1.9000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/09612033251360287","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BackgroundSystemic lupus erythematosus (SLE) is associated with significant morbidity and mortality, particularly during hospitalisation. Differentiating between infection and disease activity is crucial but challenging. Regional variations in infection rates and disease manifestations necessitate region-specific studies.ObjectivesTo evaluate whether infections at or during hospitalisation are associated with increased mortality among SLE patients and identify additional predictors of adverse outcomes.MethodsThis retrospective case-control study included SLE patients hospitalised between January 2012 and December 2021. Cases (n = 111) were patients who expired during hospitalisation, matched 1:2 with controls (n = 222) discharged alive, based on age (±3 years) and sex, stratified annually. SLE diagnosis was based on ACR 1997 or SLICC 2012 criteria. COVID-19 cases were excluded. Patients were categorised by admission cause as 'Infection', 'Disease-associated', or 'Mixed'. Data on demographics, clinical features, laboratory parameters, and treatments were extracted, and multivariable logistic regression identified independent predictors of mortality.ResultsThe hospital mortality rate was 8.9%. Infection (with or without disease activity) significantly contributed to hospital admissions among non-survivors (57%) compared to survivors (25%; p < 0.001). Acinetobacter baumannii was the most frequent pathogen. Multivariable analysis showed infection at hospitalisation (OR 3.37, 95% CI 1.85-6.13), pulmonary involvement (OR 3.06, 95% CI 1.52-6.18), cardiac involvement (OR 2.13, 95% CI 1.07-4.25), and serum creatinine levels as independent predictors of mortality. Higher serum albumin was protective (OR 0.53, 95% CI 0.35-0.79). Juvenile lupus subgroup analysis (n = 38) revealed similar infection-related mortality patterns.ConclusionsOur study highlights the significant impact of infections, particularly hospital-acquired infections, on mortality among hospitalised SLE patients. Enhanced clinical vigilance, early interventions, and rigorous infection control measures are needed to improve outcomes in hospitalised SLE patients.
期刊介绍:
The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…