John Garza, PhD
Assistant Professor
University of Texas Permian Basin, United States
Disclosure information not submitted.
Thao Dang, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Neha Panchagnula
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas
Disclosure information not submitted.
Hina Tariq, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Lavi Oud, MD
Professor
Texas Tech University Health Sciences Center
Odessa, Texas, United States
Disclosure information not submitted.
Title: Association between Systemic Lupus Erythematosus and Short-Term Mortality in Sepsis
Introduction:
Systemic lupus erythematosus (SLE) is associated with 5-times higher mortality rate due to infection, compared to the general population, and sepsis is the most common cause of death in SLE patients aged ≤50 years in the United States. We sought to estimate the association of SLE with short-term mortality in sepsis and to examine the temporal trends of mortality among septic patients with vs without SLE.
Methods:
We used the Texas Public Use Data File to identify hospitalizations aged ≥18 years with sepsis during 2014-2017. Sepsis was defined by “explicit” ICD-9 and -10 codes for severe sepsis (995.92, R65.20) and septic shock (785.52, R65.21). SLE was identified using ICD-9 and ICD-10 codes 710.0 & M32x. Multilevel multivariable logistic regression was used to examine the association of SLE with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Similar approach was used to model the temporal trends of short-term mortality among sepsis hospitalizations with and without SLE and for sensitivity analyses restricted to ICU admissions and those with septic shock.
Results:
Among 283,025 sepsis hospitalizations, 2,933 (1%) had SLE. Compared to those without SLE, SLE hospitalizations were younger (age ≥65 years, 25% vs 57%), more commonly female (88.5% vs. 50%) [p< 0.0001 for both comparisons], with similar mean [SD] number of failing organs (2.6 [1.5] vs. 2.7 [1.5]; p=0.1877). The crude short-term mortality among hospitalizations with vs without SLE was 22.9% vs 31.4%, respectively. On adjusted analyses, SLE was associated with lower short-term mortality (adjusted odds ratio [aOR] 0.76 [95% CI 0.69-0.84]), with similar findings on sensitivity analyses. The annualized trend of short-term mortality among sepsis hospitalizations with SLE was not significant (aOR 1.07 [95% CI 0.97-1.18]), while decreasing among those without SLE (aOR 0.96 [95% CI 0.95-0.97]).
Conclusions:
SLE had, unexpectedly, a “protective” association with short-term mortality in septic patients. However, the short-term mortality among sepsis hospitalizations with SLE changed insignificantly over time. Additional studies are needed to corroborate these observations, and to determine the factors underlying the observed associations and the diverging temporal trends.