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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth.

ABSTRACT: OBJECTIVE:Childhood-onset systemic lupus erythematosus (SLE) is associated with high risk for organ damage, which may be mitigated by early diagnosis and treatment. We characterized health care utilization for youth in the year preceding SLE diagnosis compared to controls. METHODS:Using Clinformatics DataMart (OptumInsight) de-identified administrative data from 2000 to 2013, we identified 682 youth ages 10-24 years with new-onset SLE (?3 International Classification of Diseases, Ninth Revision codes for SLE 710.0, each >30 days apart), and 1,364 age- and sex-matched healthy controls. We compared the incidence of ambulatory, emergency, and inpatient visits 12 months before SLE diagnosis and frequency of primary diagnoses. We examined subject characteristics associated with utilization preceding SLE diagnosis. RESULTS:Youth with SLE had significantly more visits in the year preceding diagnosis than controls across ambulatory (incidence rate ratio [IRR] 2.48, P < 0.001), emergency (IRR 3.42, P < 0.001), and inpatient settings (IRR 3.02, P < 0.001). The most frequent acute-care diagnoses and median days to SLE diagnosis were: venous thromboembolism (313, interquartile range [IQR] 18-356), thrombocytopenia (278, IQR 39-354), chest pain (73, IQR 29.5-168), fever (52, IQR 17-166), and acute kidney failure (14, IQR 5-168). Having a psychiatric diagnosis prior to SLE diagnosis was strongly associated with increased utilization across all settings. CONCLUSION:Youth with SLE have high health care utilization throughout the year preceding SLE diagnosis. Examining variable diagnostic trajectories of youth requiring acute care preceding SLE diagnosis, and increased attention to psychiatric morbidity, may help improve care for youth with new-onset SLE.

SUBMITTER: Chang JC

PROVIDER: S-EPMC5984118 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth.

Chang Joyce C JC Mandell David S DS Knight Andrea M AM

Arthritis care & research 20180816 9

<h4>Objective</h4>Childhood-onset systemic lupus erythematosus (SLE) is associated with high risk for organ damage, which may be mitigated by early diagnosis and treatment. We characterized health care utilization for youth in the year preceding SLE diagnosis compared to controls.<h4>Methods</h4>Using Clinformatics DataMart (OptumInsight) de-identified administrative data from 2000 to 2013, we identified 682 youth ages 10-24 years with new-onset SLE (≥3 International Classification of Diseases, ...[more]

PMID: 29195017

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Project description:The diagnosis of Systemic Lupus Erythematosus (SLE) is challenging due to its heterogeneous clinical presentation and lack of robust biomarkers for laboratory testing to distinguish it from other autoimmune or infectious diseases. Current diagnostic criterion relies on a combination of clinical examination and laboratory tests, and it does not readily distinguish between those with active clinical disease from those that are clinically quiescent. Several groups have attempted to apply emerging high throughput profiling technologies to diagnose SLE. Despite showing promising diagnostic potential, many of them are expensive and technically challenging for routine clinical uses. Here we report a pilot study of applying a technically simple and highly customisable leukocyte capture antibody microarray to profile healthy (n=24) and SLE patients (n=60) of various disease activities. Our analysis reveals a set of surface antigen biomarkers that have significant association with SLE. In addition, we present a computational method to calculate a score from the entire microarray profile to obtain a score that correlate most reliably with SLE disease activity. Although the current version of our microarray alone does not match the discriminatory power of the standard laboratory tests (serum dsDNA, complements C3 and C4), the combination of the two yields a test with significantly increased discriminatory ability than what can be achieved individually. This work paves the way for a customised SLE-specific antibody microarray for accurate diagnosis and monitoring of SLE that can be readily translated to routine clinical use. Blood samples were collected from 60 patients of Systemic Lupus Erythematosus (SLE) of different disease activity (11 active, 16 semi-active, and 33 inactive), and compared it with blood samples from 24 healthy blood donors. For each subject, we extracted PBMCs and apply them to a leukocyte capture antibody microarray. The microarray was then scaned by a DotScan™ slide reader (Medsaic; Eveleigh, NSW, Australia). The number of immobilized cells was proportional to the light scattered at each antibody spot. Binding of PBMCs to each antibody dot was monitored by light scatter and averaged between the duplicate spots on each slide. We then performed statistical analysis to identify CD antigen markers that are associated with SLE, as well as determining the potential diagnostic ability of this microarray for SLE.

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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth.

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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth.

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