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Prevalence of Pulmonary Embolism Among Systemic Lupus Erythematosus Discharges: A Decade of Analysis of the National Hospital Discharge Survey

Annangi, Srinadh MBBS*; Dammalapati, Tirumala Rao MBBS; Nutalapati, Snigdha MD*; Henriques King, Marshaleen N. MBBS, MSCR, FCCP*‡

JCR: Journal of Clinical Rheumatology: June 2017 - Volume 23 - Issue 4 - p 200–206
doi: 10.1097/RHU.0000000000000521
Original Articles

Introduction Pulmonary embolism (PE) is a life threatening preventable medical condition involving sudden occlusion of arteries within the lungs. Systemic lupus erythematosus (SLE) is an inflammatory disorder and therefore independently poses a risk of PE. We aimed to determine the association of SLE and PE using National Hospital Discharge Survey data, a national representative sample of hospital discharges throughout the United States.

Methods Retrospective population-based analysis was done using National Hospital Discharge Survey data for the period 2001 to 2010. International Classification of Diseases, Ninth Revision (ICD-9) coding was used to identify SLE (ICD-9 code 710.0) and PE (ICD-9 codes 415.11, 415.12, 415.13, and 415.19) mentioned in any of the discharge diagnosis. Patients 15 years or older were included in the study. Regression analysis was done including hyperlipidemia, heart failure, lower-limb injury or surgery, hypertension, diabetes cerebrovascular disease, and cancer.

Results Our regression analysis demonstrated a significant association between SLE and PE, which was independent of sex, race, age, and associated comorbidities (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.99–2.16). Of included comorbidities, primary hypercoagulable disorder has the highest odds of association with PE (OR, 15.37; 95% CI, 15.22–15.51) followed by African American race compared with whites (OR, 1.08, 95% 1.08–1.09), and presence of at least 1 of the comorbidities (OR, 1.06; 95% CI, 1.06–1.06). African American SLE cases have the higher prevalence of PE in all age groups, with the exception of persons 35 to 44 years old.

Conclusions Significant association exists between SLE and PE regardless of sex, race, age, and associated comorbidities. Females had an overall higher prevalence of SLE-related PE (1.67%) compared with males (1.29%). Stratified according to sex, race, and age groups, the association is highest for females, blacks, and age group 35 to 44 years, respectively.

From the *Department of Internal Medicine, Morehouse School of Medicine; †Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Emory University School of Medicine; and ‡Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA.

S.A. contributed to data acquisition, data management, analysis, study design, and manuscript writing. T.R.D. and S.N. contributed to data management, analysis and study design. M.N.H.K. contributed to study design and manuscript writing.

The authors declare no conflict of interest.

Correspondence: Marshaleen N. Henriques King, MBBS, MSCR, FCCP, Department of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310. E-mail: mking@msm.edu.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.