目的:传染病是自身免疫性风湿性疾病(ARD)死亡的重要原因。在感染住院的患者中,我们比较了有和无ARD患者的住院和长期(3年)死亡率.
方法:这项回顾性分析包括以色列最大的健康维护组织的成员,第一次感染时年龄>18岁,在2003-2019年期间需要住院治疗。我们比较了住院死亡率和对住院指数中幸存下来的人进行的3年里程碑分析的结果,ARD患者之间,根据疾病亚组,和没有ARD的患者。此外,我们比较了ARD患者的死亡率结果,根据亚组诊断,以1:3的比例匹配,按年龄,性别,和种族,没有ARD的患者。
结果:包括365,257例首次确诊为严重感染的患者。其中,我们确定了9,755例类风湿关节炎(RA);1,351例系统性红斑狼疮;2,120例脊柱关节炎(SPA);584例硬皮病;3,214例血管炎.在匹配的多变量分析中,RA(比值比[OR]0.89,95%置信区间[CI]0.81~0.97)和SPA(OR0.77,95%CI0.63~0.94)患者的院内死亡风险较低.在类似的分析中,RA(风险比[HR]0.82,95%CI0.78~0.86)和血管炎(HR0.86,95%CI0.80~0.93)患者的3年死亡率风险较低.
结论:在因感染住院的患者中,与没有ARD的患者相比,ARD患者的院内死亡率和3年死亡率风险没有增加.
OBJECTIVE: Infectious conditions are a significant cause of mortality in autoimmune rheumatic diseases (ARD). Among patients hospitalized with an infection, we compared in-hospital and long-term (3-year) mortality between those with and without ARD.
METHODS: This retrospective analysis included members of the largest health maintenance organization in Israel, aged > 18 years at the first episode of infection, who required hospitalization during 2003-2019. We compared in-hospital mortality and the results of a 3-year landmark analysis of those who survived the index hospitalization between patients with ARD, according to disease subgroups, and patients without ARD. Additionally, we compared mortality outcomes among patients with ARD, according to subgroup diagnosis, matched in a 1:3 ratio by age, sex, and ethnicity to patients without ARD.
RESULTS: Included were 365,247 patients who were admitted for the first time with the diagnosis of a serious infection. Of these, we identified 9755 with rheumatoid arthritis (RA), 1351 with systemic lupus erythematosus, 2120 with spondyloarthritis (SpA), 584 with systemic sclerosis, and 3214 with vasculitis. In a matched multivariate analysis, the risk for in-hospital mortality was lower among patients with RA (odds ratio [OR] 0.89, 95% CI 0.81-0.97) and SpA (OR 0.77, 95% CI 0.63-0.94). In a similar analysis, the risk of 3-year mortality was lower among patients with RA (hazard ratio [HR] 0.82, 95% CI 0.78-0.86) and vasculitis (HR 0.86, 95% CI 0.80-0.93).
CONCLUSIONS: Among patients hospitalized for an infection, the risk of in-hospital and 3-year mortality was not increased among those with ARD compared to those without ARD.