Abstract
BackgroundSepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. However, there are no population-level data on the patterns of the demand for critical care services among hospitalized septic patients with SLE or the outcomes of those admitted to the ICU.MethodsWe performed a retrospective cohort study, using the Texas Inpatient Public Use Data File, to identify SLE hospitalizations aged ≥ 18 years and the subgroups with sepsis and ICU admission during 2009–2014. The patterns of ICU admission among septic hospitalizations were examined. Logistic regression modeling was used to identify predictors of short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions with sepsis and to estimate the risk-adjusted short-term mortality among ICU admissions with and without sepsis.ResultsAmong 94,338 SLE hospitalizations, 17,037 (18.1%) had sepsis and 9409 (55.2%) of the latter were admitted to the ICU. Sepsis accounted for 51.5% of the growth in volume of ICU admissions among SLE hospitalizations during the study period. Among ICU admissions with sepsis, 25.3% were aged ≥ 65 years, 88.6% were female, and 64.4% were non-white minorities. The odds of short-term mortality among septic ICU admissions were increased among those lacking health insurance (adjusted odds ratio 1.40 [95% confidence interval 1.07–1.84]), while being unaffected by gender and race/ethnicity, and remaining unchanged over the study period. On adjusted analyses among ICU admissions, the short-term mortality among those with and without sepsis was 13% (95% CI 12.6–13.3) and 2.7% (95% CI 2.6–2.8), respectively. Sepsis was associated with 63.6% of all short-term mortality events.ConclusionsSepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE.
Highlights
Sepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients
Infections in SLE patients can be in turn difficult to distinguish from disease flare-ups [8], while immunosuppressive therapy can change the initial manifestations of infection
Because the Texas Inpatient Public Use Data File (TIPUDF) dataset provides discharge-level, rather than patient-level information, precluding accounting for repeated admissions, we report the number of hospitalizations and ICU admissions as units of analysis, rather than the number of patients
Summary
Sepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. Patients with SLE are commonly hospitalized [5] and SLE has become over the past two decades the most common autoimmune disease in the ICU [6]. Infections in SLE patients can be in turn difficult to distinguish from disease flare-ups [8], while immunosuppressive therapy can change the initial manifestations of infection. Together, these latter factors may lead to delayed diagnosis of infection and subsequent sepsis, increasing the risk of lethal outcomes. The standardized mortality rate due to infection was found to be five times higher in SLE patients than in the general population [9]
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