Aleksandra I Pivovarova1, Charat Thongprayoon2, Panupong Hansrivijit3, Wisit Kaewput4, Fawad Qureshi2, Boonphiphop Boonpheng5, Tarun Bathini6, Michael A Mao7, Saraschandra Vallabhajosyula8, Wisit Cheungpasitporn2. 1. Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA. 2. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. 3. Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17101, USA. 4. Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand. 5. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA. 6. Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA. 7. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA. 8. Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
Abstract
BACKGROUND: This study aimed to evaluate thrombotic microangiopathy's (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). METHODS: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA. RESULTS: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients. CONCLUSION: TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.
BACKGROUND: This study aimed to evaluate thrombotic microangiopathy's (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). METHODS: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLEpatients with and without TMA. RESULTS: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMApatients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMApatients. CONCLUSION:TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.
Authors: Claire Barber; Andrew Herzenberg; Ellie Aghdassi; Jiandong Su; Wendy Lou; Gan Qian; Jonathan Yip; Samih H Nasr; David Thomas; James W Scholey; Joan Wither; Murray Urowitz; Dafna Gladman; Heather Reich; Paul R Fortin Journal: Clin J Am Soc Nephrol Date: 2012-03-22 Impact factor: 8.237
Authors: Vincent Peigne; Pierre Perez; Matthieu Resche Rigon; Eric Mariotte; Emmanuel Canet; Jean-Paul Mira; Paul Coppo; Agnès Veyradier; Elie Azoulay Journal: Intensive Care Med Date: 2012-07-14 Impact factor: 17.440