Abstract 52: Predictors of Mortality in Patients With Various Rheumatological Conditions Admitted for Stroke: Findings From National Inpatient Sample 2020

Abstract

Background/Purpose: Stroke imposes a substantial healthcare burden, with ischemic stroke (IS) mortality rising from 2.04 million (1990) to 3.29 million (2019) and projected to reach 4.90 million by 2030 according to the Global Burden of Disease Study. Autoimmune diseases are increasingly associated with chronic conditions and may modify risks by altering underlying pathophysiology. We aimed to compare in-hospital mortality and predictors in stroke patients with secondary rheumatological conditions. Methods: Using the National Inpatient Sample (NIS), we identified patients ≥18 admitted for stroke (Jan 2019 - Dec 2020), stratified into RA, SLE, scleroderma, or vasculitides groups using ICD-10-CM codes. We compared demographics, hospital traits, comorbidities, and outcomes. In-hospital mortality, our primary outcome, was analyzed through multivariate logistic regression using STATA 18. Results: Incorporating a cohort of 32,180 stroke patients, consisting of 23,439 with rheumatoid arthritis (RA), 7,080 with systemic lupus erythematosus (SLE), 960 with scleroderma, and 700 with vasculitides, the main findings are as follows: Mortality rates were 5.73% (n=1345) for RA, 6.28% (n=445) for SLE, 9.37% (n=90) for scleroderma, and 10.71% (n=75) for vasculitides, with no significant disparity between the latter three and RA. Age emerged as a significant mortality predictor (OR 1.01, p <0.01, CI 1.00 to 1.02), while no associations were observed for gender, race, insurance, or hospital traits. Regarding comorbidities, congestive heart failure (OR 1.73, p <0.01, CI 1.32 to 2.26) and liver disease (OR 2.20, p < 0.01, CI 1.27 to 3.79) exhibited connections to higher mortality, while no significant associations were detected for hypertension, dyslipidemia, chronic obstructive pulmonary disease, kidney disease, coronary artery disease, diabetes, obesity, or peripheral vascular disease. Conclusions: Rheumatological diseases, inducing cytokine-mediated systemic inflammation, potentially modify risks in stroke-admitted patients. This study uniquely compares stroke mortality and predictors across distinct rheumatological diseases, revealing age, congestive heart failure, and liver disease as significant mortality predictors.