Infections Needing Hospital Stay Costly for Scleroderma Patients in US

Pneumonia and sepsis are the most common serious infections among scleroderma patients needing hospitalization in the U.S., a study reports.

Its findings also show that while the length of time these people remains in a hospital dropped slightly from 1998 to 2016, their hospital charges rose considerably.

The study, “Serious infections in people with systemic sclerosis: a national US study,” was published in the journal Arthritis Research & Therapy.

Infection is known to contribute significantly to mortality in people with scleroderma, but few studies have delved into the incidence, trends, and outcomes of infections requiring hospitalization in this patient population.

Researchers from The University of Alabama at Birmingham addressed this gap by searching the U.S. National Inpatient Sample registry, the country’s largest public and all-payer inpatient healthcare database, for information spanning 1998 to 2016.

They identified 49.9 million hospitalizations involving serious infections during this period, 61,615 of which were in people with scleroderma.

Overall, scleroderma patients tended to be younger than the other patients (median age of 62 vs. 65). They were also more likely to be female (84% vs. 52%), and to have more than one medical condition, known as comorbidities.

Over the study period, median hospital stays were longer (4.4 vs. 3.7 days) and hospital charges were higher for scleroderma patients ($22,105 vs. $16,832) compared with other patients. In-hospital mortality among scleroderma patients stood at 9%, compared with 6.2% among those with other disorders.

The most common serious infections among the scleroderma group were pneumonia (45%) and sepsis (32%) over all years studied. Other infections included skin and soft tissue infections (19%), opportunistic infections (3%), and urinary tract infections (3%).

Although opportunistic infections resulted in the longest median hospital stays, most serious infections in the scleroderma group led to longer stays, and hospital charges tended to be highest for cases involving sepsis, at approximately $38,118.

Sepsis cases increased most markedly over the study period, compared with other infections, rising from one to seven cases per 100,000 hospitalizations, and surpassing pneumonia in 2013–14. Pneumonia remained stable at approximately four cases per 100,000.

From 1998 and 2000, average hospital charges for serious infections in scleroderma patients were $23,152, rising to $87,095 by 2015–16. At the same time, the average length of hospital stays decreased from 4.6 days in 1998–2000 to 4.2 days in 2015–16. In-hospital mortality also lowered from 10.3% to 7.8%, with the greater reductions seen in opportunistic infections, sepsis, and pneumonia.

This represented a 3.6 times increase in costs of a hospitalization, despite a 9% average decrease in the length of a hospital stay, the researchers wrote.

Sepsis, advanced age (80 years and older), and two or more comorbidities were associated with higher use of healthcare services and mortality. By comparison, using Medicare or Medicaid, being in the Northeast, access to an urban hospital, and medium or large hospital bed sizes all associated with greater healthcare services use but not with higher mortality.

“Outcomes in people with SSc [scleroderma] hospitalized with serious infections have improved over time, except higher hospital charges,” the scientists wrote. “Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.”