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Epidemiology, Time-trends and Outcomes of Serious Infections in Patients With Vasculitis: A 19-year National Study


Arthritis Care Res (Hoboken). 2020 Jun 11.doi: 10.1002/acr.24348. Online ahead of print.

Jasvinder A Singh 1 2 3, John D Cleveland 2

Author Information

1 Medicine Service, Birmingham VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, 35233, USA.

2 Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA.

3 Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA.


Objective: To examine the epidemiology/time-trends/outcomes of serious infections and type in people with vasculitis in the U.S.

Methods: We identified people with vasculitis hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTI), or opportunistic infections (OI) in the 1998-2016 U.S. National Inpatient Sample. We used adjusted logistic regression to examine the predictors of hospital stay >3 days, total hospital charges >median, discharge to non-home setting, and in-hospital mortality.

Results: We noted 111,345 serious infections in people with vasculitis (14% of all vasculitis hospitalizations). The mean age was 67.3 years, Deyo-Charlson comorbidity score was ≥2 in 54%, 37% were males, 67% white. Serious infection hospitalization rate per 100,000 NIS claims in 1998-2000 versus 2015-2016 (and increase) in people with vasculitis were as follows: Overall, 12.14 to 25.15 (2.1-fold); OI, 0.78 vs. 0.83 (1.1-fold); SSTI, 1.38 versus 2.52 (1.8-fold); UTI, 0.35 versus 1.48 (4.2-fold); pneumonia, 7.10 vs. 6.23 (0.9-fold); and sepsis, 2.53 vs. 14.10 (5.6-fold). Pneumonia was the most common serious infection (58%) in 1998-2000, versus sepsis (56%) in 2015-2016. Sepsis, older age, Deyo-Charlson index ≥2, urban hospital, or medium/large hospital bed size, were associated with higher healthcare utilization and in-hospital mortality; Northeast region, Medicare and Medicaid payer type were associated with higher healthcare utilization.

Conclusions: Hospitalized serious infection rates are increasing in vasculitis, except pneumonia. Sepsis was the most common serious infection in 2015-2016. Several patient and hospital factors are associated with healthcare utilization and mortality in serious infection hospitalization in vasculitis.

Keywords: Vasculitis; epidemiology; health services utilization; hospitalizations; mortality; opportunistic infection; pneumonia; sepsis; serious Infection; skin and soft tissue infections; urinary tract infection.