Ehizogie Edigin

Background: Stevens−Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions associated with significant morbidity and mortality. Published studies have identified a limited number of variables predictive of death, but their description of acute complications is sparse. Objectives: To analyse adult hospitalizations for SJS/TEN using a national claims‐based database, characterize associated acute complications and determine how these complications influence in‐hospital mortality. Methods: We retrospectively identified adult hospitalizations with SJS/TEN from the 2017−2022 National Inpatient Sample (NIS) Database. Variables with p ≤ 0.2 in univariable screening were included in the multivariable logistic regression, with significance set at p ≤ 0.05. Results: Among 29,875 adult SJS/TEN hospitalizations over the 6‐year study period, 7.9% died in the hospital. On univariable analysis, the strongest predictors of mortality were disseminated intravascular coagulation (DIC) (OR 19.15), respiratory failure (OR 15.79), anoxic brain injury (OR 12.38) and hepatic failure (OR 9.86); all p < 0.001. African American race, Medicare insurance, aspiration pneumonia, systolic heart failure, myocardial infarction, hyponatremia and pulmonary embolism lost significance after multivariable adjustment. On multivariable analysis, the following factors were associated with in‐hospital death: age per year (OR 1.03), Charlson Comorbidity Index (CCI) per point (OR 1.11; 95% CI 1.062–1.168), acidosis (OR 2.49), acute kidney injury (AKI) (OR 1.96; 95% CI 1.509–2.557), anoxic brain damage (OR 4.77), DIC (OR 4.16; 95% CI 2.439–7.089), encephalopathy (OR 1.38; p = 0.032), hepatic failure (OR 3.18; 95% CI 1.999–5.066), infection (OR 1.95) and respiratory failure (OR 6.80; 95% CI 5.250–8.805); all p < 0.001 unless otherwise noted. Limitations: This retrospective analysis relies on an administrative database with diagnoses identified by billing codes, which are subject to misclassification and it lacks data on disease severity (body surface area involvement), culprit drugs, laboratory values and treatment, limiting adjustment for confounding by indication. Only in‐hospital mortality was assessed, not longer‐term outcomes. Conclusions: In‐hospital mortality among adult SJS/TEN patients was 7.9% and was associated with older age, greater comorbidity burden and the presence of clinical complications including acidosis, AKI, anoxic brain damage, DIC, encephalopathy, hepatic failure, infection and respiratory failure. Early identification and proactive management of high‐risk patients, particularly those with organ dysfunction, may be critical to reducing mortality in this vulnerable population. These results offer actionable insights for clinicians to reduce the mortality of SJS/TEN patients.

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Background/Objective: To evaluate in-hospital mortality after coronary artery bypass graft (CABG) surgery in patients with and without systemic lupus erythematosus (SLE) using a large contemporary nationwide inpatient database. Methods: Using the 2016 to 2022 National Inpatient Sample database, we identified adults undergoing CABG surgery and compared those with and without SLE. Demographics, comorbidities, socioeconomic factors, and perioperative outcomes were analyzed. Multivariable logistic regression was used to assess factors associated with in-hospital mortality. Results: Among 1,342,510 CABG hospitalizations, 4260 (0.3%) involved patients with SLE. Compared with non-SLE patients, those with SLE were younger (median 63 vs. 67; P P P P P P <0.001). SLE itself was not independently associated with in-hospital death (adjusted OR: 0.92; 95% CI: 0.635-1.340). Factors independently associated with in-hospital mortality included older age, female sex, concurrent valve surgery, and greater comorbidity burden. Higher-income quartiles and private insurance were protective. Rates of major perioperative complications were generally similar between the groups, although respiratory failure occurred more frequently in SLE patients. Conclusions: After adjusting for demographic and clinical factors, SLE was not independently associated with mortality during CABG surgery hospitalization. These findings suggest that SLE alone may not independently increase in-hospital mortality risk after CABG surgery.

Septic arthritis (SA) is a medical emergency associated with substantial morbidity and mortality. Although the knee is the most commonly affected joint in adults, contemporary national data describing characteristics, mortality, and healthcare utilization in knee-specific native SA are limited. We conducted a retrospective study of adult hospitalizations for nongonococcal native knee SA in the United States using the National Inpatient Sample database from 2016 to 2022. Hospitalizations were identified using ICD-10 diagnostic codes, excluding gonococcal and prosthetic joint infections. Thus, the analytic cohort was restricted to native joint disease and did not include prosthetic joint infection. Weighted analyses were performed to generate national estimates. Multivariable logistic regression was used to identify factors independently associated with in-hospital mortality. Among approximately 205 million adult hospitalizations, 92,290 (0.045%) had native SA of the knee. In-hospital mortality was 2.5%. Patients who died were older, had longer lengths of stay, and incurred more than double the median hospital charges compared with survivors. In multivariable analysis, factors independently associated with higher odds of in-hospital death included respiratory failure (odds ratio [OR] 8.54), sepsis (OR 3.57), liver disease (OR 3.45), cerebrovascular disease (OR 2.27), acute kidney injury (OR 2.05), chronic kidney disease (OR 1.66), myocardial infarction (OR 1.60), heart failure (OR 1.55), and increasing age. Survivors demonstrated substantial postacute care needs, with 36% discharged to skilled nursing or intermediate care facilities. In this nationally representative cohort, nongonococcal native septic knee arthritis showed substantial in-hospital mortality, morbidity, and healthcare utilization. Mortality was driven primarily by multiorgan dysfunction rather than demographic or socioeconomic factors. Early identification and aggressive management of high-risk patients may improve outcomes.

Background Coronavirus-19, primarily a respiratory virus, affects multiple organs and can lead to exacerbation of autoimmune or systemic conditions. Patients with autoimmune diseases, rheumatoid arthritis particularly, are susceptible to infection and complications from COVID-19. RA has become well-associated with COVID-19 infections, but large-scale studies evaluating outcomes among this vulnerable group are limited. Methods For the retrospective analysis, we used the National Inpatient Sample database to compare COVID-19 patients with and without RA. A total of 1,050,040 adult hospitalizations were included in the study between January 1 to December 31, 2020: COVID-19 with RA (n = 21,545; 2.1%) and COVID-19 without RA (n = 1,028,495; 97.9%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation requirement, vasopressor use, cardiac arrest, cardiogenic shock, acute kidney injury, acute kidney injury requiring hemodialysis, gastrostomy, tracheostomy, length of stay, health care utilization costs, and disposition. A secondary analysis evaluating in-hospital mortality and mechanical ventilation with respect to age was conducted. Results COVID-19 patients with RA had significantly increased in-hospital mortality compared to COVID-19 patients without RA (12.9% vs 11.1%, adjusted OR [aOR]: 1.2 [95% CI 1.1-1.3], p < 0.001). This cohort also had significantly increased rates of mechanical ventilation, pressor use, and cardiogenic shock. Conclusions Given limited large evidence regarding COVID-19 with respect to RA, future research should be focused on this topic to improve outcomes for this subset of patients.

Background There is a scarcity of national population-based studies on polymyositis (PM)/dermatomyositis (DM) readmissions in the USA. In this study, we aim to describe the rates, reasons for readmissions, and characteristics of readmissions for adults hospitalized for PM/DM in the USA. Methods We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult DM/PM patients with a principal diagnosis of PM/DM using ICD-10 codes. We excluded elective and traumatic readmissions. Using a “rank” command in STATA, the most common specific principal diagnosis of readmissions was outlined. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. STATA 16 was used for analysis. Results A total of 1610, 1286, and 842 index hospitalizations with a principal diagnosis of PM/DM, that were discharged alive, were included in the 30-, 90-, and 180-day readmission analysis, respectively. Among these, 193 (12%), 276 (21.5%), and 240 (28.5%) were readmitted within 30, 90, and 180 days, respectively. PM and sepsis were the most common reasons for reasons across the 3 timeframes. 30-day readmissions were responsible for an aggregate of 4.1 million US dollars in total hospital cost and 1518 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions have higher Charlson Comorbidity Index scores, severe-extreme loss of function, obesity, and deep venous thrombosis. Conclusion About a third of PM/DM hospitalized patients are readmitted within 180 days. Readmissions constitute a significant economic burden to the health care system. PM and sepsis are the main reasons for readmissions. Key points • About a third of polymyositis (PM)/dermatomyositis (DM) hospitalized patients are readmitted within 180 days • PM and sepsis are the main reasons for readmissions. • Readmissions of PM/DM Patients constitute a significant economic burden to the health care system. • Compared to index hospitalizations, 30-day readmissions have higher Charlson comorbidity index scores, severe-extreme loss of function, obesity, and deep venous thrombosis.

Background Longitudinal data on the trends in systemic lupus erythematous (SLE) readmissions are limited. We aimed to study trends in 30-day readmissions of patients admitted for SLE flares and all SLE hospitalizations in the USA from 2010 to 2018. Materials and methods Data were obtained from the nationwide readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis using the 2010–2018 NRD databases. We searched for index hospitalizations of adult patients diagnosed with SLE using the International Classification of Diseases (ICD) codes. Elective and traumatic readmissions were excluded from the study. Multivariable logistic and linear regression analyses were used to calculate the adjusted p value trend for categorical and continuous outcomes, respectively. Results The 30-day readmissions following index admissions of all SLE patients and for SLE flares decreased from 15.6% in 2010 to 13.3% in 2018 (adjusted p trend < 0.0001), and 20.3% in 2010 to 17.6% in 2018 (adjusted p trend = 0.009) respectively. Following SLE-flare admissions, hospital length of stay (LOS) decreased from 6.7 to 6 days (adjusted p trend = 0.045), while the proportion with a Charlson comorbidity index (CCI) score ≥ 3 increased from 42.2 to 54.4% (adjusted p trend < 0.0001) during the study period. SLE and its organ involvement, sepsis, and infections were common reasons for 30-day readmissions. Conclusion About 1 in 5 SLE-flare admissions resulted in a 30-day readmission. The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have decreased in the last decade. Although the readmission LOS was reduced, the CCI score increased over time. Key Points • The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have reduced in the last decade although the CCI score increased over time. • SLE, its organ involvement, and infections are common reasons for readmission. • Infection control strategies, optimal management of SLE and its complications, and emphasis on an ideal transition of care are essential in reducing SLE readmissions.

Background Longitudinal data are limited on systemic lupus erythematosus (SLE) hospitalizations. We aim to study longitudinal trends of SLE hospitalizations in the last 2 decades in the United States (U.S). Methods Data were obtained from the National Inpatient Sample database (NIS). We performed a 21-year longitudinal trend analysis of NIS 1998–2018. We searched for hospitalizations for adult patients with a “principal” diagnosis of SLE (SLE flare group) and those with “any” diagnosis of SLE (all SLE hospitalization group) using ICD codes. All non-SLE hospitalizations for adult patients were used as the control. Multivariable logistic and linear regression were used appropriately to calculate adjusted p-trend for the outcomes of interest. Results Incidence of SLE flare hospitalization reduced from 4.1 to 3.2 per 100,000 U.S persons from 1998 to 2018 (adjusted p-trend < 0.0001). The proportion of all hospitalized patients with SLE admitted principally for SLE reduced from 11.3% in 1998 to 5.7% in 2018 (adjusted p-tend < 0.0001). The proportion of hospitalized blacks in the SLE flare and all SLE hospitalization groups increased from 37.7% and 26.9% in 1998 to 44.7% and 30.7% in 2018 respectively (adjusted p-trend < 0.0001). The proportion of hospitalized Hispanics and Asians disproportionally increased in SLE flare hospitalizations compared to the control group. Conclusion The incidence of hospitalization for SLE flare has reduced in the last 2 decades in the U.S. The proportion of hospitalized patients with SLE admitted principally for SLE has reduced significantly over time. However, the burden of SLE hospitalizations among ethnic minorities has increased over time. Key Points • The incidence of hospitalization for SLE flare has reduced in the last 2 decades in the U.S. • The proportion of hospitalized patients with SLE admitted principally for SLE has reduced significantly over time. • The burden of SLE hospitalizations among ethnic minorities such as blacks has increased over time.