AB0866-HPR INPATIENT RHEUMATOLOGY HEALTHCARE IN A TERTIARY REFERRAL ACADEMIC HOSPITAL
Authors: Gamboa-Alonso C. M. , Figueroa-Parra G. , De-Leon-Ibarra A. L. , Díaz-Angulo J. , Serna-Peña G. , Vega-Morales D. , Galarza-Delgado D. Á. 
Published: May 2021

Background:

Diagnosis of autoimmune diseases (AD) has been increasing in recent years, with a prevalence of 3- 5% worldwide. The causes that lead to an inpatient approach in patients with suspicion or a confirmed rheumatic disease (RD) vary widely.

RD are at higher risk of infectious, cardiovascular and other comorbidities due to immunosuppression, a continuous inflammatory state and an altered immune response, increasing morbidity and mortality rates.

Objectives:

Describe hospitalized patients who required a rheumatology consultation due to a preexistent or a new RD.

Methods:

A descriptive, observational study was performed during a three year follow up (March 2017 -February 2020) in a University Hospital in Mexico. We included patients with definite or suspicion of a RD who received a rheumatologic evaluation. Demographic and clinical characteristics, length of stay and complications such as infection, readmission, use of mechanical ventilation and mortality were registered. Descriptive statistics were used. Binary regression models were applied to find association between clinical factors and infection/mortality in RD hospitalized patients, SPSS v20 was used to perform statistical analysis. A P< 0.05 was considered statistically significant.

Results:

A total of 642 hospitalized patients received a rheumatologic evaluation. Of the evaluated patients, 315 (49.1%) had a history of a confirmed RD, of these, 237 (75.2%) were hospitalized due to a complication associated to the underlying RD and 78 were hospitalized for other non-rheumatic nor related disorder and were omitted for the rest of the analysis; 327 (50.9 %) patients were evaluated for the first time, 147 (45.0%) of them being diagnosed with a new RD; Systemic Lupus Erythematosus (SLE) 55 (37.4%) was the most frequent diagnosis. Figure 1

Of the 642 evaluated patients, 384 (59.81%) patients with a previous (237) or new (147) rheumatic cause of hospitalization were studied. Table 1A

Factors associated to infection and mortality in the 384 patients are shown in Table 1B.

Conclusion:

Inpatient rheumatologic evaluation is a major concern of healthcare due to the severity and prognosis of these diseases. SLE was found to be the most common diagnosis in patients evaluated for the first time. Infection is an important cause of hospitalization and mortality, being the use of steroids and immunosuppression some of the main risk factors of these outcomes.

References:

[1]O’Sullivan O, Bateman J, Jobanputra P. 172 Acute Rheumatology Referrals are Increasing: A Service Evaluation of more than 1000 Consecutive Acute Inpatient Referrals from a Tertiary Centre. Rheumatology. 1 de abril de 2016;55(suppl_1):i131-2.

Table 1A.

Descriptive analysis of patients receiving a Rheumatology evaluation

Total evaluated patientsRheumatic cause of hospitalizationNew rheumatic diseasen=642n=384n=147Age (SD) Mean39 (25-53)40 (25-53)40.56 (16-89)SexFemale462 (72%)285 (74.2%)94 (63.9%)Median days of follow up6 (4-11)6 (3-11)7 (2-11)Previous immunosupression225 (35%)156 (40.6%)16 (10.9%)Previous steroid use197 (30.7%)132 (34.4%)12 (8.2%)Mechanical ventilation60 (9.3%)26 (6.8%)11 (7.5%)Infection248 (38.6%)148 (38.5%)51 (34.7%)Mortality59 (9.2%)39 (10.2%)13 (8.8%)Readmission106 (16.5%)89 (23.2%)14 (9.5%)Table 1B.

Association between clinical factors and infection/mortality

InfectionUnivariateMultivariateβ (95 % CI)β (95 % CI)Age1.02 (1-1.02)1.02 (1.01-1.03)Use of mechanical ventilation4.82 (1.97-11.77)4.28 (1.67-10.97)Previous use of steroids1.55 (1.01-2.39)1.33 (0.74-2.4)Previous use of immunosupression1.37 (0.9-2.07)1.16 (0.65-2.04)Readmission1.76 (1.02-3.02)1.4 (0.76-2.56)MortalityAge0.71 (0.99-1.02)0.99 (0.98-1.02)Use of mechanical ventilation7.09 (2.95-17.04)8.54 (2.89-25.23)Previous use of steroids1.95 (1-3.8)0.97 (0.39-2.39)Previous use of immunosupression2.58 (1.31-5.1)3.06 (1.21-7.72)Infection3.66 (1.81-7.37)2.96 (1.41-6.23)Readmission1.33 (0.58-3.05)0.42 (0.14-1.24)

p <0.05 *

Disclosure of Interests:

None declared