1Miral Hamed Ahmed Gharib,1Karima Becetti, 1Fiaz Alam, 1Aishwariya Padmakumari, 1Mohamed AL Kahlout, 1Rawan Saleh, 1Amina Bougalia, 1Bilal Jamshaid, 1Samar AL-Emadi
1Hamad Medical Corporation
Systemic Lupus Erythematosus is characterized by diverse clinical presentations and a remarkably unpredictable course. Although survival rate has increased in recent decades, morbidity and mortality are still substantially high, resulting in multiple hospital admissions. Winning the battle against lupus requires a good understanding of the causes of SLE-related hospital admissions and the predictors of morbidity and mortality, in order to implement the early necessary interventions to reduce poor outcomes in hospitalized patients. Because SLE disease course, prognosis, and management vary across races and countries, understanding these factors in different populations is highly important.
Material(s) and Method(s):
Electronic records of SLE patients admitted to Hamad General Hospital over a period of 3 years were reviewed to obtain patients’ demographics, clinical characteristics and hospitalization outcomes, and identify predictors of intensive care unit (ICU) admission and poor outcomes. Descriptive statistics were used to summarize data and presented as percentages and mean± SD. Multiple logistic regression analysis to identify predictors of disease outcomes in relation to various features was conducted. Non-Parametric correlation was expressed as correlation coefficient (r) and p-value <0.05 was considered to be significant.
A total of 110 patients were analyzed with mean age 34.6±10.9 years, 84% were females and 56% Arabs. Disease duration was 5.5±7.3 years, 43% had renal involvement and 40% were on steroids (mean dose 7.5±12.9 mg/day). Main reason for hospitalization was hematological flares in 27%, articular in 20%, and infections in 28%. Sepsis occurred in 22% of patients and renal impairment in 41% with 14% needing renal replacement therapy. Mean hospitalization length was 10.3±10.7 days, 47% had ≥ 2 admissions, 17% required ICU admissions and 1 death occurred due to sepsis. ICU admissions were associated with neuropsychiatric flares (odds ratio [OR] 12.7, 95% confidence interval [CI] 1.7 – 94.7), higher disease activity (SELENA-SLEDAI-2k, OR 1.1, 95% CI 1.0-1.2), cardiovascular causes (OR 11.9, 95% CI 1.4 – 98.0),
complications including renal impairment (OR 4.2, 95% CI 1.1 – 15.8) and heart failure (OR 14.6, 95% CI 1.4 – 149.9), higher number of admissions (OR 2.2, 95% CI 1.3 – 3.9) and longer hospital stay (OR 1.3, 95% CI 1.1 – 1.4).
In this multinational cohort, sepsis, renal, neuropsychiatric, cardiovascular complications, high disease activity and recurrent hospital admissions were associated with poor outcomes which were consistent with previous studies.
• Although the proportion of ICU admissions was substantially high in this population, the mortality was relatively low, reflecting the level of care.
• The findings of this study will help us better predict poor outcomes in order to implement early interventions to reduce morbidity and mortality.