Thirty-Day Hospital Readmissions for Granulomatosis With Polyangiitis in the United States: A Nationwide Analysis.

BACKGROUND/OBJECTIVE: Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that often results in frequent hospitalizations. We investigated the characteristics and predictors of 30-day hospital readmissions in GPA. METHODS: We performed a cross-sectional analysis using the 2014 National Readmission Database. We included nonelective admissions with a primary or secondary diagnosis of GPA. We compared characteristics between readmissions and nonreadmissions. Independent predictors for readmissions were studied using mixed-effects multivariable logistic regression. RESULTS: We evaluated a total of 9749 hospital admissions with GPA, among which there were 2173 readmissions (22.3%) within 30 days of discharge. The top 5 primary reasons for readmissions were GPA, sepsis, pneumonia, acute respiratory failure, and acute kidney injury. Granulomatosis with polyangiitis readmissions were associated with higher length of stay (8.0 vs 7.2 days; p = 0.019) and less discharge home (50% vs 63%, p < 0.001). Independent predictors for readmissions were younger age (odds ratio [OR], 0.99; p = 0.013), no private insurance (OR, 0.50; p < 0.001), higher Charlson Comorbidity Index (OR, 1.12; p = 0.039), congestive heart failure (OR, 1.71; p = 0.001), acute kidney injury (OR, 1.39; p = 0.005), and discharge to home health care (OR, 1.29; p = 0.039). CONCLUSIONS: We found a significant burden of 30-day readmissions among GPA populations. Clinicians should be vigilant regarding patients with high risk of readmissions, including those with younger age, public insurance, higher comorbidity burden, cardiac and renal complications, and unfavorable discharge dispositions.

Systemic sclerosis and the risk of perioperative major adverse cardiovascular events for inpatient non-cardiac surgery.

AIM: We investigated the association between systemic sclerosis (SSc) and perioperative cardiovascular risk for inpatient non-cardiac surgical procedures. METHODS: We used data from the National Inpatient Sample (NIS) for the year 2014 to identify patients undergoing inpatient non-cardiac surgery. SSc and major adverse cardiovascular events (MACE) were defined by International Classification of Diseases 9th Revision diagnosis codes. Univariate and multivariate analyses were performed. We adjusted for demographic information, socioeconomic status, cardiac comorbidities, cardiovascular risk factors and procedural category. Two models were used with different categorization strategies for surgical procedures. RESULTS: A total of 8 156 379 hospitalizations for non-cardiac surgeries were included, 4385 of which had a diagnosis of SSc. Patients with SSc were older, more likely to be female and Caucasian and with higher cardiac and systemic comorbidity burden. In univariate analysis, SSc was associated with higher risk of perioperative MACE (odds ratio [OR] = 2.9; P < 0.001) and all-cause death (P = 3.07; P < 0.001). Multivariate analysis yielded conflicting results regarding the association between SSc and perioperative MACE (Model 1: OR = 1.42; P = 0.146; Model 2: OR = 1.59; P = 0.048). Subsequent analysis showed that only perioperative myocardial infarction (Model 1 OR = 1.85; P = 0.048; Model 2 OR = 1.94; P = 0.031) was independently associated with SSc. CONCLUSION: We did not find consistent association between SSc and perioperative MACE in non-cardiac surgical procedures. SSc may be associated with perioperative myocardial infarction.

Rheumatoid arthritis is associated with increased in-hospital mortality in asthma exacerbations: a nationwide study.

The relationship between RA and asthma has been yielding conflicting results, with most recent studies showing a possible positive association. The study aims at the outcomes of adult patients hospitalized for asthma exacerbation in those with and without RA. We used data from the National Inpatient Sample (NIS) for the period of 2012-2014. ICD 9 code was used to identify the diagnosis. Our primary outcome was in-hospital mortality. Our secondary outcome was total asthma exacerbation hospitalizations, length of stay, and total hospital charges. Compared to those without RA, RA was associated with increased hospitalizations for asthma exacerbation (unadjusted OR 1.29, p < 0.001; adjusted OR 1.06, p = 0.002), more respiratory and systemic comorbidities, increased in-hospital mortality (unadjusted OR 1.89, p = 0.001; adjusted OR 1.60, p = 0.020), length of stay (4.5 vs 3.8; unadjusted p < 0.001, adjusted p < 0.001), and total hospital charges (30,149 vs 26,247; unadjusted p < 0.001, adjusted p = 0.048). Our study was the first to demonstrate that RA is associated with increased in-hospital mortality, length of stay, and cost using a national inpatient database. We hypothesize that in asthmatic patients with concurrent RA, their asthma may represent a distinctive subgroup that is more severe and carries a poorer prognosis, which deserves more attention and future investigation.

Macrophage Activation Syndrome, Glomerulonephritis, Pericarditis, and Retinal Vasculitis as Initial Presentation of Systemic Lupus Erythematosus.

Macrophage activation syndrome (MAS) is a rare manifestation of systemic lupus erythematosus (SLE) with potentially life-threatening consequences. To the best of our knowledge, this is the first case reported in literature for a constellation of MAS, glomerulonephritis, pericarditis, and retinal vasculitis as initial presentation of SLE. Despite extensive multisystem involvement of his disease, the patient responded well to initial steroid treatment, with mycophenolate mofetil successfully added as a steroid-sparing agent. Our case highlights the importance of multispecialty collaboration in the diagnosis and management of SLE with multisystem involvement.