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In-hospital Mortality Associated with Granulomatosis with Polyangiitis and Microscopic Polyangiitis Complicated with
Francisco F Costa Filho1, Vanita Motiani2, Alan Furlan2
1Pulmonary and Critical Care Fellowship, Corewell Health West, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
Background And Aim:
Our study aimed to determine the in-hospital mortality rate among granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) hospitalizations complicated with acute respiratory failure (ARF) in the US and determine prognostic factors during hospitalization.
Method:
We performed a retrospective cohort analysis utilizing the National In-patient Sample (NIS) database to identify hospitalizations of patients with GPA or MPA associated with ARF from 2016 to 2021. The outcomes included in-hospital mortality, requirement of invasive procedures, and hospital length of stay. Univariable and multivariable analysis were used to identify prognostic factors associated with in-hospital mortality.
Results:
We identified 21,430 weighted (4,283 unweighted) hospitalizations with diagnosis of GPA or MPA associated with ARF in the United States from 2016 to 2021. 78.3% of those were diagnosed with GPA, 19.2% with MPA, and 2.5% with both ICD-10 codes. The mean age was 63.7 years, 53.6% were female, and 73.3% were White. The rate of hemodialysis was 21.5%, plasmapheresis 7.4%, and extracorporeal membrane oxygenation in 0.5% of hospitalizations. The overall in-hospital mortality was 15.4%, compared to 35.9% in the subgroup requiring invasive mechanical ventilation (IMV). Independent prognostic factors associated with increased in-hospital mortality were higher age, acute kidney injury (AKI), sepsis, requirement of non-invasive mechanical ventilation, interstitial lung disease (ILD), history of stroke, shock, and requirement of IMV.
Conclusion:
GPA or MPA hospitalizations complicated with ARF were found to be associated with a high in-hospital mortality rate. At hospital-level prognostication assessment, we found that higher age, AKI, sepsis, shock, history of ILD, history of stroke, and requirement of mechanical ventilation were independently associated with increased in-hospital mortality.
Insights
Hospitalizations for granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) complicated by acute respiratory failure (ARF) have high mortality. Older age, acute kidney injury, sepsis, and mechanical ventilation are key factors predicting in-hospital death.
Area of Science:
- Rheumatology
- Pulmonology
- Critical Care Medicine
Background:
- Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are severe autoimmune diseases.
- Acute respiratory failure (ARF) is a critical complication in GPA and MPA patients.
- Understanding mortality and prognostic factors in these hospitalizations is crucial for patient care.
Purpose of the Study:
- To determine the in-hospital mortality rate for GPA/MPA hospitalizations with ARF in the US.
- To identify prognostic factors associated with in-hospital mortality during these hospitalizations.
Main Methods:
- Retrospective cohort analysis of the National Inpatient Sample (NIS) database (2016-2021).
- Identification of hospitalizations for GPA or MPA with ARF.
- Univariable and multivariable analyses to identify mortality predictors.
Main Results:
- Over 21,000 weighted hospitalizations for GPA/MPA with ARF were identified.
- Overall in-hospital mortality was 15.4%, rising to 35.9% for those requiring invasive mechanical ventilation (IMV).
- Independent predictors of mortality included higher age, acute kidney injury (AKI), sepsis, shock, interstitial lung disease (ILD), stroke history, and IMV.
Conclusions:
- GPA/MPA hospitalizations with ARF carry a significant risk of in-hospital mortality.
- Key factors for prognostication include age, AKI, sepsis, shock, ILD, stroke, and mechanical ventilation requirement.
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