COVID-19 Infection and Clinical Outcomes in Hospitalized Patients With Rheumatoid Arthritis: Insights From the National Inpatient Sample.

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.

Outcomes in systemic sclerosis patients hospitalized with COVID-19: Insight from the National Inpatient Sample.

Objective: COVID-19, a respiratory infection caused by the novel coronavirus SARS-CoV-2, can cause varying degrees of illness ranging from mild respiratory illness to severe respiratory failure. Systemic sclerosis is a chronic autoimmune disease, with an increased prevalence of infections as compared to the general population. In this study, we compare the clinical outcomes and resource utilization for COVID-19 hospitalizations in patients with and without systemic sclerosis. Methods: We used the National Inpatient Sample database, 2020, to study the characteristics, morbidity, mortality, cost, and resource utilization among primary COVID-19 hospitalizations with and without systemic sclerosis. Results: There were 1,050,040 patients aged ⩾ 18 years with a diagnosis of COVID-19. Of these, 775 (0.07%) patients had a secondary diagnosis of systemic sclerosis. Although there was no statistically significant difference regarding individual outcomes; in-hospital mortality, vasopressor use, cardiac arrest, acute kidney injury, and disposition to facility were numerically higher in hospitalizations with systemic sclerosis. The composite endpoint of major adverse events was higher in the systemic sclerosis cohort (adjusted odds ratio 1.52, 95% confidence interval: 1.06-2.17, p = 0.022). Conclusion: COVID-19 patients with systemic sclerosis had worse outcomes (i.e. higher composite endpoint of major adverse events) than those without systemic sclerosis. Further studies are needed to establish a better understanding of the relationship between COVID-19 and systemic sclerosis.

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample.

Background: There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD). Methods: We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD. Results: Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups. Conclusion: According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.

Polymyositis/dermatomyositis readmissions: analysis of the nationwide readmission database.

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.

Analysis of Cutaneous Lupus Hospitalizations: A United States National Population-Based Study.

Background There are limited studies analyzing cutaneous lupus erythematosus (CLE) hospitalizations. In this study, we aimed to analyze baseline demographics of systemic lupus erythematosus (SLE) and CLE patients, identify the most common reasons for hospitalizations, and find out the hospitalization outcomes.  Materials and methods We performed the analysis using the National (Nationwide) Inpatient Sample (NIS) database between 2016 and 2019. For the CLE cohort, data for adults aged 18 years and older with the primary or secondary diagnosis of CLE using International Classification of Disease - 10th revision (ICD-10) codes were extracted. For comparison, the SLE cohort was identified by patients aged 18 years and older with primary or secondary diagnoses of SLE using ICD-10 codes. Chi-squared test was used to compare baseline demographic characteristics. Multivariable logistic and linear regression was used to calculate outcomes of interest. Results In comparison to the SLE cohort, the CLE cohort was not only older in age and lower percentage female, but also had shorter length of stay, less total hospital charge, and the majority had Medicare as primary insurance. The SLE cohort included predominantly African American patients while the CLE cohort was majority Caucasian patients. The cardiovascular risks were more prevalent in the CLE cohort and most commonly admitted for sepsis, cardiovascular disease, and mental health disorders. Conclusion Our study highlights the importance of outpatient follow-up in CLE patients to closely monitor cardiovascular risk factors, early identification of infections, and routine mental health screenings to reduce hospitalizations and resource utilization.

Severe major depressive disorder readmissions: A national United States population study.

BACKGROUND: National population data are scarce on readmission following hospitalization for severe major depressive disorder (SMDD) in the United States (U.S.). We aim to describe the rates, characteristics, and reasons for readmissions for adults hospitalized for SMDD in the U.S. METHODS: We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult patients (≥18 years) with a "principal" diagnosis of SMDD using (ICD)-10 codes. We excluded elective readmissions. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. The 10 most common reasons for readmission were highlighted. RESULTS: A total of 236,284, 185,737, 120,218, and 21,645 index hospitalizations with a principal diagnosis of SMDD discharged alive, were included in the 30-, 90-180- and 330-day readmission analysis. Among these, 27,443 (11.6 %), 36,844 (19.8 %), 32,269 (26.8 %) and 7915 (36.6 %) were readmitted within 30, 90, 180 and 330 days, respectively. 90-day readmissions were older, had more males, greater hospital costs, fewer patients with private insurance, higher comorbidity burden, more patients from lower-income households, present to metropolitan hospitals, and leave against medical advice compared to index admissions. LIMITATIONS: Limitations of our study include possible coding errors, lack of data on race/ethnicity, age of disease onset, duration of illness, medication use, and adherence. CONCLUSIONS: About 1 in 3 patients admitted for SMDD are readmitted within 11 months. Readmissions constitute a significant economic burden and differ from index admissions. SMDD and other psychiatric disorders are common reasons for readmission. Interventions to reduce readmissions are needed.

Longitudinal Trends of Hospitalizations for Giant Cell Arteritis: A 21-Year Longitudinal National Population-Based Study.

Background Long-term longitudinal studies on giant cell arteritis (GCA) hospitalizations are limited. Here we aim to fill gaps in knowledge by analyzing longitudinal trends of GCA hospitalizations over the last two decades in the United States (U.S.). Materials and methods We performed a 21-year longitudinal trend analysis of GCA hospitalizations using data obtained from the National Inpatient Sample (NIS) database between 1998 and 2018. Using the NIS database, we searched for hospitalizations for patients aged ≥ 50 years with a principal diagnosis of GCA using ICD billing codes. The principal diagnosis was the main reason for hospitalization. We used all hospitalizations in patients without GCA aged ≥50 years as the control population. Multivariable logistic and linear regression analysis was utilized to calculate the adjusted p-trend for outcomes of interest. Results The incidence of GCA hospitalization remained stable at about one per 100,000 U.S. persons throughout the study period. There was no statistically significant change in the inpatient mortality for the GCA group during the study period (adjusted p-trend=0.111). In comparison, inpatient mortality reduced from 4.4% to 3.1% from 1998 to 2018 (adjusted p-trend <0.0001) in the control group. The proportion of whites reduced, while the proportion of racial minorities increased over time in both the GCA and control groups. Conclusion The non-GCA control population saw significant reductions in mortality over time, but unfortunately, the GCA group did not see such improvements. More research into additional treatment modalities for inpatient GCA management may help improve mortality.

Most common reasons for emergency department presentation among patients with psychiatric disorders: A United States nationwide analysis.

BACKGROUND: There is a scarcity of national United States (U.S.) data on emergency department (ED) utilization among patients with psychiatric disorders (PD). This study aims to determine the most common reasons for ED visits among patients with PD, and baseline characteristics of patients who present to the ED due to PD. METHODS: We obtained data from the Nationwide Emergency department Sample (NEDS), the largest all-payer ED database in U.S. Each ED visit in NEDS 2018, can have only 1 "principal" diagnosis, which is the main reason for the visit and up to 34 "secondary" diagnoses. We abstracted data for all ED visits with "any" diagnosis of a PD, using the ICD-10 code "F". We highlighted the 10 most common "principal" diagnoses based on organ-system involved, and most specific "principal" diagnoses for all ED visits by patients with "any" diagnosis of PD. We then highlighted baseline characteristics of ED visits with a "principal" diagnosis of PD. RESULTS: A total of 38.4 million ED visits for patients with PD, among these, 5,911,984 had PD as the principal diagnosis. Patients who presented principally due to PD were more likely to come from lower income household. Mental disorders and injuries and poisoning were the most common principal diagnosis by organ system categories for patients with PD. LIMITATIONS: Possibility of coding errors and absence of date on race. CONCLUSIONS: Anxiety disorder, alcohol intoxication and major depressive disorder (MDD) were the most common specific psychiatric "principal" diagnosis for ED presentation among patients with PD.

Analysis of Emergency Department Visits by Patients With Giant Cell Arteritis: A National Population-Based Study.

Background There is scarcity of national level data on the reasons for Emergency Department (ED) presentation among patients with Giant cell arteritis (GCA) in the United States. This study aims to outline the most common reasons for ED presentation among these patients, and the baseline characteristics and outcomes of ED visits principally for GCA.  Materials and methods We obtained data from the Nationwide Emergency Department Sample (NEDS) 2018 database. Each ED visit in the NEDS has a principal diagnosis (the main reason for the visit) and can have up to 34 other secondary diagnoses. We searched for ED visits for patients aged ≥50 with any diagnosis of GCA using ICD-10 codes. The most common principal discharge diagnoses were divided into organ systems, and specific principal discharge diagnoses were recorded for ED visits among patients with GCA in descending order of frequency. We then outlined baseline characteristics and outcomes of ED visits with a principal diagnosis of GCA. Results There were 20,886 ED visits for patients with GCA in 2018. Infections, as well as rheumatologic and cardiovascular disease were the most common reasons for ED presentation, and GCA was the most common specific principal discharge diagnosis for ED visits. There were 3888 ED visits with a principal diagnosis of GCA. These patients were predominantly elderly females, admitted, Medicare insured, with minimal comorbidity burden, and presented to metropolitan teaching hospitals in the south. Conclusion GCA patients are most likely to present to the ED due to their underlying GCA. Infections and CV are also common reasons for presentation to the ED.

Systemic lupus erythematous readmissions have reduced: a 9-year longitudinal study of the nationwide readmission database.

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.

Longitudinal trends of systemic lupus erythematous hospitalizations in the United States: a two-decade population-based study.

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.

Emergency Department Utilization by Patients With Eating Disorders: A National Population-Based Study.

Background There is a scarcity of national United States (U.S) data on emergency department (ED) utilization by patients with eating disorders. This study aims to determine the most common reasons for ED visits of patients with eating disorders, as well as baseline characteristics of patients who present due to eating disorders. Methods We obtained data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the United States. Each ED visit in NEDS 2018 can have only one "principal" diagnosis, which is the main reason for the visit and up to 34 "secondary" diagnoses. We abstracted data for all ED visits with "any" diagnosis of an eating disorder, using the ICD-10 code "F50". We highlighted the 10 most common "principal" diagnoses based on the organ system involved and the 10 most specific "principal" diagnoses for all ED visits by patients with any diagnosis of eating disorder. We then highlighted baseline characteristics of ED visits with a "principal" diagnosis of an eating disorder. Results There were a total of 56,901 ED visits for patients with eating disorders in 2018. Among these, 7,979 had an eating disorder as the "principal" diagnosis. Patients who visited the ED principally for eating disorders were more likely to be young females and came from higher-income households; about a third were admitted with 22.1 million U.S. dollars in aggregate ED charges. Mental disorders, and injuries and poisoning were the most common principal diagnosis by organ system categories, while eating disorders, major depression disorder (MDD), hypokalemia, and dehydration are common specific reasons for ED visits among patients with eating disorders. Conclusions Eating disorders, and its medical complications and psychiatric comorbidities such as MDD are common reasons for ED visits among patients with eating disorders. Management of the underlying eating disorder and their psychiatric comorbidities through a multidisciplinary approach in the outpatient setting is invaluable in reducing ED utilization by these patients.

Pediatric Heart Failure Inpatient Mortality: A Cross-Sectional Analysis.

Background Heart failure constitutes significant morbidity and mortality among the pediatric population. Few data exist on the prevalence and mortality rate of pediatric heart failure (pHF) in the United States. Objectives This study aimed to determine the in-hospital mortality and the principal diagnoses in pediatric patients with heart failure who died while being hospitalized in the United States. Methods This is a retrospective cross-sectional study using data from the 2019 Kid Inpatient Database (KID). The KID contained data on hospitalized children below 21 years of age. Using Stata 17 software (StataCorp LLC, College Station, Texas), the data were searched for heart failure diagnoses using International Classification of Diseases 10th revision Clinical Modification (ICD-10-CM) codes. By using the "rank" command in Stata, the most common principal diagnoses were placed in descending order of frequency, and these were further divided into different ICD-10 code categories. Results There were 16,206 pHF admissions in 2019. Of these admissions, 1,023 (6.31%) patients died. The top five principal ICD 10 code categories among all pHF deaths in descending order were circulatory system (17.95%), congenital/chromosomal abnormalities (17.43%), respiratory system (10.28%), infectious diseases (9.24%, and perinatal diseases (7.90%). Among all pHF deaths, sepsis of unspecified organisms (5.14%), hypoplastic left heart syndrome (HLHS) (3.19%), and acute respiratory failure with hypoxia (3.14%) were the most common primary diagnoses. Conclusion and significance Pediatric heart failure in-hospital overall mortality is 6.31%, and sepsis of unspecified organisms, HLHS, and acute respiratory failure are the most common principal diagnoses among these children. Preventive measures and prompt treatment of infections are paramount to reducing pHF mortality.

Emergency department utilization by patients with bipolar disorder: a national population-based study.

BACKGROUND: There is a scarcity of national United States (US) data on emergency department (ED) utilization of patients with bipolar disorder (BD). This study aims to determine the most common reasons for ED visits of patients with BD, and baseline characteristics of patients who present due to BD. METHODS: We obtained data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the US. Each ED visit in NEDS 2018, can have only 1 "principal" diagnosis, which is the main reason for hospitalization, and up to 34 "secondary" diagnoses. We extracted data for all ED visits with "any" diagnosis of BD, using the ICD-10 code. We highlighted the 5 most common "principal" diagnoses based on the organ system involved and the 10 most specific "principal" diagnoses for all ED visits by patients with "any" diagnosis of BD. We highlighted baseline characteristics of ED visits with a "principal" diagnosis of BD. RESULTS: A total of 2,200,197 ED visits for patients with BD in 2018. Mental disorders such as BD, suicidal ideations, anxiety disorders and injuries and poisoning were common reasons for presentation to the ED. Among these, 291,319 had BD as the principal diagnosis. These patients were more likely to come from lower-income households. LIMITATIONS: Possibility of coding errors due to ICD coding, and absence of data on race and medication compliance. CONCLUSIONS: BD, suicidal ideation, and anxiety disorders were the most common specific psychiatric reasons for presentation to the ED among patients with BD.

Left atrial appendage closure using WATCHMAN device in chronic kidney disease and end-stage renal disease patients.

BACKGROUND: Chronic kidney disease (CKD) and end-stage renal disease are considered independent risk factors for developing atrial fibrillation (AF). Percutaneous occlusion of left atrial appendage (LAAC) using WATCHMAN device is a widely accepted alternative to anticoagulation therapy to prevent ischemic stroke in AF in patients who are not candidates for anticoagulation. There is limited data regarding the utilization and periprocedural safety of this intervention in patients with CKD/ESRD. METHODS: We retrospectively reviewed all hospitalizations from 2016 to 2017 with (ICD-10) procedure diagnosis code of LAA closure using WATCHMAN procedure with and without a secondary diagnosis of CKD/ESRD in acute-care hospitals across the United States using the national inpatient sample. Demographic variables (gender, race, income, hospital characteristics, medical comorbidities) were collected and compared. The primary outcomes were inpatient mortality, hospital length, and cost of stay. RESULTS: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Sixteen thousand five hundred five hospitalizations were for adult patients with a procedure code for LAA closure via watchman procedure. Of 16,505 patients, 3245 (19.66%) had CKD and ESRD. There was no statistically significant difference in mortality, length, and cost of stay in patients with and without CKD/ESRD. There were no statistically significant differences in periprocedural cerebrovascular accidents in both groups. CONCLUSION: Patients with and without ESRD/CKD who undergo LAA occlusion with Watchman have similar procedure related, in-hospital mortality, and complications.

Primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome: analysis of the National Inpatient Sample.

INTRODUCTION: Primary angiitis of the central nervous system (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS) are two rare syndromes that affect the cerebral vasculature. Both conditions have been shown to cause severe neurologic complications. Distinguishing these two conditions in clinical practice is often challenging. Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population. MATERIALS AND METHODS: We conducted a retrospective review of hospitalizations with a diagnosis of PACNS or RCVS from 2016 to 2018 in the National Inpatient Sample (NIS) database. Multivariate analysis was performed to calculate adjusted odds ratios (ORadj) for hospital outcomes. RESULTS: In the NIS, 3305 hospitalizations had a diagnosis of RCVS and 6035 hospitalizations had a diagnosis of PACNS. RCVS hospitalizations had a significantly greater association with cerebral aneurysms (ORadj 23.80), hemiplegia/hemiparesis following subarachnoid hemorrhage (SAH) (ORadj 324.09), ischemic stroke (ORadj 7.59), and nontraumatic SAH (ORadj 253.61). PACNS hospitalizations had a significantly greater association with hemiplegia/hemiparesis following cerebrovascular accident (CVA) (ORadj 6.16), ischemic stroke (ORadj 11.55), nontraumatic SAH (ORadj 7.29), seizure (ORadj 2.49), and in-hospital mortality (ORadj 2.85). CONCLUSIONS: We performed an analysis of the NIS to better understand RCVS and PACNS hospitalizations. Severe neurologic events including CVA and SAH were elevated in both, but SAH and related hemiplegia/hemiparesis were extremely common among RCVS hospitalizations. In-hospital mortality was elevated in PACNS but not RCVS. This information can be used to help clinicians better understand, distinguish, and diagnose these conditions. Key Points • Despite clear description of RCVS and PACNS in the medical literature, there remains a scarcity of national population-based studies comparing these two entities against the general adult inpatient population. • This study aims to fill knowledge gaps in this area. • Here, we compare the clinical features and outcomes of RCVS and PACNS hospitalizations against the general adult inpatient population.

Rheumatoid Arthritis Patients Have Better Outcomes Than Non-Rheumatoid Arthritis Patients When Hospitalized for Ischemic Stroke: Analysis of the National Inpatient Sample.

OBJECTIVES: The aims of this study were to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of RA. METHODS: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for hospitalizations for adult patients with ischemic stroke as principal diagnosis with and without RA as secondary diagnosis using International Classification of Diseases, 10th Revision codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator, and mechanical thrombectomy were secondary outcomes of interest. Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. RESULTS: There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. Of 525,570 patients with ischemic stroke, 8670 (1.7%) had RA. Hospitalizations for ischemic stroke with RA had less inpatient mortality (4.7% vs. 5.5%; adjusted odds ratio, 0.66; 95% confidence interval, 0.52-0.85; p = 0.001), shorter LOS (5.1 vs 5.7 days, p < 0.0001), lower mean total hospital charges ($61,626 vs. $70,345, p < 0.0001), and less odds of undergoing mechanical thrombectomy (3.9% vs. 5.1%; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.72; p < 0.0001) compared with those without RA. CONCLUSIONS: Hospitalizations for ischemic stroke with RA had less inpatient mortality, shorter LOS, lower total hospital charges, and less likelihood of undergoing mechanical thrombectomy compared with those without RA. However, the odds of receiving tissue plasminogen activator were similar between both groups. Further studies to understand its mechanism would be helpful.