To examine the time-trends in hospitalized infections in systemic lupus erythematosus (SLE) and the factors associated with healthcare utilization and in-hospital mortality.
We used the U.S. National Inpatient Sample data from 1998-2016 to examine the epidemiology, time-trends and outcomes of five, common hospitalized infections in people with SLE, namely, pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTI) and opportunistic infections (OI). Time-trends were compared using the Cochran Armitage test. Multivariable-adjusted logistic regression models examined the factors associated with healthcare utilization (hospital stay >3 days, hospital charges above median, or discharge to non-home setting) and in-hospital mortality.
The hospitalization rate/100,000 claims in 1998-2000 versus 2015-2016 (and increase) were as follows: OI, 1.13 vs. 1.61 (1.2-fold); SSTI, 4.78 versus 12.2 (2.5-fold); UTI, 1.94 versus 6.12 (3.2-fold); pneumonia, 15.09 vs. 17.05 (1.1-fold); and sepsis, 6.31 vs. 39.64 (6.3-fold). In 2011-12, sepsis surpassed pneumonia as the most common hospitalized infection in SLE. In multivariable-adjusted models, sepsis diagnosis, older age, Deyo-Charlson score ≥2, Medicare or Medicaid insurance, and urban hospital location were significantly associated with increased odds of in-hospital mortality and all healthcare utilization outcomes; and the black race was significantly associated with increased odds of healthcare utilization.
Our study found increasing rates of hospitalized infections in SLE over time, the surpassing of pneumonia by sepsis as the most common infection, and identified risk factors associated with poorer outcomes. This can inform patients, providers and policy-makers regarding SLE infection burden and lead to interventions/pathways to improve outcomes.

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