Serious infections in people with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA): a time-trend national US s
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ORIGINAL ARTICLE
Serious infections in people with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA): a time-trend national US study Jasvinder A. Singh 1,2,3
&
John D. Cleveland 2
Received: 16 March 2020 / Revised: 20 April 2020 / Accepted: 23 April 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective To assess incidence, time-trends, and outcomes of serious infections in people with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA). Methods We examined the 1998–2016 US National Inpatient Sample for serious infections in PMR or GCA, namely, opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia. Multivariable-adjusted logistic regressions assessed association of the type of infection, demographics, comorbidity, and hospital characteristics with healthcare utilization and mortality. Results Hospitalized with serious infections, those with PMR or GCA were 2 decades older than people without PMR or GCA, and more likely to be female or white or have higher Deyo-Charlson index score or higher income. Sepsis rates in the general population, PMR, and GCA cohorts were 10.2%, 17.7%, and 18.9% in 2015–2016, respectively. Incidence rates of serious infections/100,000 NIS claims in PMR and GCA in 2015–2016 were as follows (rounded off): OI, < 1 and < 1; SSTI, 4 and 1; UTI, 4 and 1; pneumonia, 9 and 2; and sepsis, 20 and 4, respectively. Sepsis surpassed pneumonia as the most common serious infection in 2011–2012. In multivariable-adjusted analyses in the PMR cohort, sepsis, female sex, Deyo-Charlson comorbidity score ≥ 2, Medicare or Medicaid insurance, urban hospital location, and large hospital bed size were associated with significantly higher healthcare utilization and/or in-hospital mortality. Similar associations were noted in the GCA cohort. Conclusions Incidence of serious infections, especially sepsis, increased in both PMR and GCA cohorts over time. Interventions to improve serious infection outcomes in PMR/GCA are needed. Key Points • PMR/GCA patients with hospitalized serious infections were 2 decades older than the general population. • Sepsis surpassed pneumonia as the commonest hospitalized serious infection in PMR/GCA in 2011–2012. • Sepsis, female sex, comorbidity, Medicare/Medicaid insurance, and urban location were associated with higher healthcare utilization and in-hospital mortality.
Keywords Epidemiology . GCA . Healthcare utilization . Mortality . Outcomes . PMR . Giant cell arteritis . Polymyalgia rheumatica . Serious infections Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05129-w) contains supplementary material, which is available to authorized users. * Jasvinder A. Singh [email protected] 1
Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA
2
Department of Medicine, School of Medicine, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 3
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