Dataset Information

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study.

ABSTRACT: Background:Hospitalized patients with systemic lupus erythematosus (SLE) often require critical care, and SLE is the most common autoimmune disease in the intensive care unit (ICU). Mental disorders are highly prevalent among patients with SLE and are associated with increased morbidity and premature death in this population. However, the association of mental disorders with ICU utilization among patients with SLE and their prognostic impact among those admitted to ICU is unknown. Methods:We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File to identify SLE hospitalizations aged ? 18 years during 2009 - 2014. Mental disorders were defined by the taxonomy of the Healthcare Cost and Utilization Project's Clinical Classification Software Category 5. The patterns of ICU admission among SLE hospitalizations with and without mental disorders were examined. Multivariable logistic regression modeling was used to examine the association of mental disorders and short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions. Results:Among 94,338 SLE hospitalizations 35,793 (37.9%) had mental disorders. There was no difference in the rates of ICU admission among SLE hospitalizations with and without mental disorders (37% vs. 37.2%, respectively; P = 0.5999), and similar rates of mental disorders were found among SLE hospitalizations with and without ICU admission (37.8% vs. 38%, respectively; P = 0.5408). The volume of SLE ICU admissions with and without mental disorders rose between 2009 and 2014 by 60.3% vs. 7.9%, respectively. When compared to those without mental disorders, SLE ICU admissions with mental disorders were older (age ? 65 years, 23.6% vs. 21.4%, respectively) and had higher burden of comorbid conditions. Unadjusted short-term mortality among SLE ICU admissions with and without mental disorders was 4.8% and 5.8%, respectively and mental disorders were associated with lower short-term mortality on adjusted analyses (adjusted odds ratio (aOR): 0.826; 95% confidence interval (CI): 0.734 - 0.930). Conclusions:There was no difference in the frequency of mental disorders among hospitalized patients with SLE with and without ICU admission. However, the growth in the volume of ICU admissions with SLE over time involved predominantly patients with mental disorders. Among ICU admissions, mental disorders were associated with lower short-term mortality.

SUBMITTER: Oud L

PROVIDER: S-EPMC7430872 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study.

Oud Lavi L

Journal of clinical medicine research 20200722 8

<h4>Background</h4>Hospitalized patients with systemic lupus erythematosus (SLE) often require critical care, and SLE is the most common autoimmune disease in the intensive care unit (ICU). Mental disorders are highly prevalent among patients with SLE and are associated with increased morbidity and premature death in this population. However, the association of mental disorders with ICU utilization among patients with SLE and their prognostic impact among those admitted to ICU is unknown.<h4>Met ...[more]

PMID: 32849939

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Project description:ObjectiveTo estimate the incidence and prevalence of systemic lupus erythematosus (SLE) in a sociodemographically diverse southeastern Michigan source population of 2.4 million people.MethodsSLE cases fulfilling the American College of Rheumatology classification criteria (primary case definition) or meeting rheumatologist-judged SLE criteria (secondary definition) and residing in Wayne or Washtenaw Counties during 2002-2004 were included. Case finding was performed from 6 source types, including hospitals and private specialists. Age-standardized rates were computed, and capture-recapture was performed to estimate underascertainment of cases.ResultsThe overall age-adjusted incidence and prevalence (ACR definition) per 100,000 persons were 5.5 (95% confidence interval [95% CI] 5.0-6.1) and 72.8 (95% CI 70.8-74.8). Among females, the incidence was 9.3 per 100,000 persons and the prevalence was 128.7 per 100,000 persons. Only 7 cases were estimated to have been missed by capture-recapture, adjustment for which did not materially affect the rates. SLE prevalence was 2.3-fold higher in black persons than in white persons, and 10-fold higher in females than in males. Among incident cases, the mean ± SD age at diagnosis was 39.3 ± 16.6 years. Black SLE patients had a higher proportion of renal disease and end-stage renal disease (ESRD) (40.5% and 15.3%, respectively) as compared to white SLE patients (18.8% and 4.5%, respectively). Black patients with renal disease were diagnosed as having SLE at younger age than white patients with renal disease (mean ± SD 34.4 ± 14.9 years versus 41.9 ± 21.3 years; P = 0.05).ConclusionSLE prevalence was higher than has been described in most other population-based studies and reached 1 in 537 among black female persons. There were substantial racial disparities in the burden of SLE, with black patients experiencing earlier age at diagnosis, >2-fold increases in SLE incidence and prevalence, and increased proportions of renal disease and progression to ESRD as compared to white patients.

Project description: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.

Dataset Information

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study.

Publications

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study.

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