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Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: A
Chanyuan Wu1, Qian Wang1, Linrong He2
1Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Background:
Polymyositis and dermatomyositis (PM/DM) are systemic autoimmune diseases with multiple organ involvements that manifest as muscular and cutaneous disorders, interstitial lung disease (ILD) and malignancies. However, information concerning the outcomes and associated factors for PM/DM patients who are hospitalized is limited.
Methods:
We retrospectively reviewed the medical charts of PM/DM patients admitted to a Chinese tertiary referral hospital (Peking Union Medical College Hospital, PUMCH) from 2008 to 2014. The deceased group included 63 patients who had "deceased discharge" status or were confirmed to have died within two weeks of hospital discharge. The demographic data, clinical manifestations, and direct causes of death were analyzed retrospectively. Medical records for 126 age- and sex-matched PM/DM patients were selected as controls from 982 inpatients successively admitted to the same center during the same period. In addition to the comparison of clinical manifestations between the two groups, binary logistic regression was conducted to explore the risk factors related to PM/DM mortality.
Results:
Over the past 6 years at PUMCH, the in-hospital mortality rate of PM/DM patients was 4.58%. The male gender and the elder patients had a high risk of death (P = 0.031 and P = 0.001 respectively). The three most frequent causes of death for PM/DM patients were pulmonary infection (35%), ILD exacerbation (21%) or both conditions (25%). Pulmonary infection (P<0.001, OR = 5.63, 95% CI, 2.37-13.36), pneumomediastinum (P = 0.041, OR = 11.02, 95%CI, 1.10-110.54), Gottron's papules (P = 0.010, OR = 3.24, 95%CI, 1.32-7.97), and elevated erythrocyte sedimentation rate (ESR) (P = 0.005, OR = 9.9, 95%CI 2.0-49.0) were independent risk factors for in-hospital mortality of PM/DM patients.
Conclusion:
PM/DM patients continue to display high in-hospital mortality. Pulmonary infection is the strongest predictor of poor prognosis in PM/DM patients, followed by pneumomediastinum, Gottron's papules, and elevated ESR.
Insights
Polymyositis and dermatomyositis (PM/DM) patients have high in-hospital mortality. Pulmonary infection is the strongest predictor of poor prognosis, followed by pneumomediastinum, Gottron
Area of Science:
- Rheumatology
- Internal Medicine
- Pulmonology
Background:
- Polymyositis and dermatomyositis (PM/DM) are systemic autoimmune diseases affecting multiple organs.
- These conditions manifest as muscular, cutaneous, and interstitial lung disorders, and are associated with malignancies.
- Limited data exists on outcomes and risk factors for hospitalized PM/DM patients.
Purpose of the Study:
- To investigate the in-hospital mortality rate and identify risk factors for death in patients with polymyositis and dermatomyositis (PM/DM).
Main Methods:
- Retrospective review of medical charts of 126 PM/DM patients admitted to a Chinese tertiary hospital from 2008-2014.
- Comparison of demographic data, clinical manifestations, and causes of death between deceased patients and age/sex-matched controls.
- Binary logistic regression analysis to determine independent risk factors for in-hospital mortality.
Main Results:
- The in-hospital mortality rate for PM/DM patients was 4.58%.
- Male gender and older age were associated with increased mortality risk.
- Pulmonary infection, interstitial lung disease (ILD) exacerbation, pneumomediastinum, Gottron's papules, and elevated erythrocyte sedimentation rate (ESR) were identified as independent risk factors for mortality.
Conclusions:
- PM/DM patients face significant in-hospital mortality risks.
- Pulmonary infection is the primary predictor of poor prognosis in PM/DM patients.
- Pneumomediastinum, Gottron's papules, and elevated ESR also independently predict mortality.
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