A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis

Sara G. Murray, Gabriela Schmajuk, Laura Trupin, Erica Lawson, Matthew Cascino, Jennifer Barton, Mary Margaretten, Patricia P. Katz, Edward H. Yelin, Jinoos Yazdany

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM. Methods Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population. Results A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6). Conclusion Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.

Original languageEnglish (US)
Pages (from-to)673-680
Number of pages8
JournalArthritis Care and Research
Volume67
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Dermatomyositis
Hospital Mortality
Infection
Population
Mortality
Confidence Intervals
Hospitalization
Odds Ratio
Comorbidity
Inpatients
Logistic Models
Myositis
Mycoses
Opportunistic Infections
Bacteremia
Bacterial Infections
Health Care Costs
Pneumonia
Regression Analysis

ASJC Scopus subject areas

  • Rheumatology

Cite this

A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis. / Murray, Sara G.; Schmajuk, Gabriela; Trupin, Laura; Lawson, Erica; Cascino, Matthew; Barton, Jennifer; Margaretten, Mary; Katz, Patricia P.; Yelin, Edward H.; Yazdany, Jinoos.

In: Arthritis Care and Research, Vol. 67, No. 5, 01.05.2015, p. 673-680.

Research output: Contribution to journalArticle

Murray, SG, Schmajuk, G, Trupin, L, Lawson, E, Cascino, M, Barton, J, Margaretten, M, Katz, PP, Yelin, EH & Yazdany, J 2015, 'A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis', Arthritis Care and Research, vol. 67, no. 5, pp. 673-680. https://doi.org/10.1002/acr.22501
Murray, Sara G. ; Schmajuk, Gabriela ; Trupin, Laura ; Lawson, Erica ; Cascino, Matthew ; Barton, Jennifer ; Margaretten, Mary ; Katz, Patricia P. ; Yelin, Edward H. ; Yazdany, Jinoos. / A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis. In: Arthritis Care and Research. 2015 ; Vol. 67, No. 5. pp. 673-680.
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abstract = "Objective Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM. Methods Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population. Results A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5{\%} (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95{\%} confidence interval [95{\%} CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95{\%} CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95{\%} CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95{\%} CI 1.4-1.6). Conclusion Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.",
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AU - Lawson, Erica

AU - Cascino, Matthew

AU - Barton, Jennifer

AU - Margaretten, Mary

AU - Katz, Patricia P.

AU - Yelin, Edward H.

AU - Yazdany, Jinoos

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N2 - Objective Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM. Methods Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population. Results A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6). Conclusion Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.

AB - Objective Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM. Methods Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population. Results A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6). Conclusion Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.

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