All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre

OBJECTIVE: To determine factors affecting morbidity and mortality in a contemporary cohort of hospitalized SLE patients and estimate the rate of SLE hospitalization. METHODS: A retrospective chart review was done on all patients admitted to London Health Sciences Centre and St Joseph's Health Centre in London, Ontario, Canada, between January 2006 and June 2009. RESULTS: There were a total of 96 SLE patients meeting inclusion criteria hospitalized during this period resulting in 154 hospitalizations. Average age at diagnosis was 33.3 years (s.d. 13.7) and 46.5 years (s.d. 14.1) at hospitalization; 91.7% of hospitalized patients were female. The most common reasons for hospitalization included disease flare (17.5%), infection (mostly bacterial) (16.2%) and adverse drug reaction (8.1%). Acute coronary syndrome (2.6%) and venous thromboembolic events (1.9%) were less common causes of hospitalization. Mean hospitalization length was 8.5 (s.d. 11.2) days. Intensive care unit (ICU) admission occurred in 22 cases (13.8%) and mortality was significantly higher (27.3% of ICU patients died; P < 0.001). ICU admissions were associated with longer hospitalization 18.6 (s.d. 17.8) days; P = 0.006. The annual rate of hospitalizations for SLE was estimated as between 8.6% and 18.9% per year depending on the estimated size of the referral area and study year. CONCLUSION: In this contemporary cohort, SLE flare and infection remain the top reasons for hospitalization. Causes of admission and length of stay are consistent with previous studies conducted in North America. The proportion of ICU admissions was substantially higher in this population and was associated with increased mortality and length of hospitalization.