SAT0597 EARLY DAMAGE AS MEASURED BY SLICC/ACR DAMAGE INDEX IS A PREDICTOR OF HOSPITALIZATION IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: L. Raman, F. Yahya, C. M. Ng, S. Sockalingam, R. J. B. Raja Mohamed
Journal: Annals of the Rheumatic Diseases (2020)

Background: Hospital admissions and re-admissions in lupus patients are common occurrences that can lead to mortality. The predictive factors influencing hospitalizations and mortality are variable in literature. Objectives: We evaluated the leading causes of hospitalizations and mortality and their predictive factors in the multi-ethnic SLE patients. Methods: A retrospective study was done on SLE patients from University Malaya Medical Centre and diagnosed for at least 1 year. Data were collected from 1988 until 2019. Demographic and disease details, causes of hospital admissions and mortality were reviewed from electronic medical records. Baseline and latest disease activity (SLEDAI 2K) and SLICC/ACR damage index (SDI) scores were evaluated. Results: A total of 300 SLE patients, 285 (95%) of whom were females were included in this study. Majority were of Chinese ethnicity 150 (50%), followed by Malays 108 (36%), Indians 39 (13%) and others 3 (1%). The cohort’s median age was 48 (18-82) years and median disease duration was 14 (1-72) years. Median age at SLE diagnosis was 27.5 (6-72) years. 133 (44.3%) had SDI score of ≥1 at baseline (early damage). 23% had developed new organ damage during this study period. There were 222 (74%) patients ever hospitalized and 12 (5.4%) deaths from this cohort. The main cause of hospitalization was lupus flare which included concurrent infection (n=415 admissions, 46%), followed by elective admissions for procedures and others (n=284 admissions, 31.5%). 17% of admissions were due to infections with concurrent flare (8.7% were due to infection alone). Admissions for treatment and disease related complications were 13.8%. Median length of stay for SLE related cause admissions was longer compared to non-SLE related causes, 10 (range 1-113) vs 7.5 (range 1-130) days. Causes of death included SLE flare without features of infection (25%), concurrent lupus flare and infection (25%), and non-SLE causes (50%). Malignancy (33.3%) was the main cause of death in non-SLE deaths. Independent predictive factors for hospitalization and mortality are shown in Table 1 and Table 2. Table 1. Multivariate logistic regression analysis for the predictors of hospitalization HOSPITALIZATION Parameters B Coefficient OR (95% C. I ) p value Ethnicity Malay 2.005 7.428 (0.181-226.883) 0.26 Chinese 1.287 3.623 (0.089-106.163) 0.47 Indian 1.695 5.446 (0.126-177.222) 0.35 Disease Duration - 0.015 0.985 (0.953-1.020) 0.40 Comorbids ≥ 2 1.673 5.328 (0.843-105.481) 0.14 APLS 1.784 5.956 (1.883-26.685) 0.001* Serology markers Anti-Smith 1.840 6.298 (1.733-40.638) 0.01* Anti-SSA 1.211 3.360 (1.758-6.640) &lt;0.001* ACR Serositis 2.656 14.248 (2.555-275.071) 0.01* Neurological 1.706 5.506(1.403-36.834) 0.01* SCORES SDI Baseline 0.552 1.737 (1.062-3.048) 0.01* Table 2. Multiple logistic regression analysis of the predictors for mortality MORTALITY Parameters B Coefficient OR (95% C. I ) p value Disease duration 0.095 1.099 (1.031-1.183) 0.001* Comorbids ≥2 3.161 23.618 (1.997-344.533) 0.01* APLS 2.556 12.888 (1.592-136.512) 0.01* SDI Renal 2.167 8.734 (1.385-80.528) 0.01* Malignancy 3.936 51.218 (6.725-616.957) 0.001* Pulmonary 1.696 5.452 (0.684-41.395) 0.1 SCORES SLEDAI latest 0.275 1.316 (1.161-1.556) 0.001* Conclusion: Early damage in lupus as measured by SDI is of predictive value of hospitalization. Optimization in managing patients with pre-existing damage is crucial to reduce hospitalization risk and subsequent complications. References: [1]GP Rosa, et al . Causes and factors related to hospitalizations in patients with SLE: analysis of a 20-year period (1995–2015) from a single referral centre in Catalonia. Lupus . 2019;28(9):1158-66. [2]P Rahman, et al. Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in SLE. Lupus . 2001;10(2), 93-6. Disclosure of Interests: None declared