Article Figures & Data
Figures
- Figure 1.
Inpatient mortality for children and adolescents with a diagnosis of systemic lupus erythematosus (SLE) showed a statistically significant decrease over the years of study (OR 0.95, 95% CI 0.900–0.998, p = 0.04). Mortality for those with SLE nephritis also showed a statistically significant decrease (OR 0.93, 95% CI 0.88–0.99, p = 0.01). Mortality for all other KID hospitalizations showed a statistically significant but very minor decrease (OR 0.97, 95% CI 0.96–0.97, p < 0.001). The difference in rate of mortality decrease for hospitalizations with SLE diagnosis versus those without a SLE diagnosis was not statistically significant. Error bars indicate standard error; the error bars for the group of hospitalizations without an SLE diagnosis are so small that they are barely visible on the graph. KID: US Kids’ Inpatient Database.
- Figure 2.
A. The most common 75% of billed procedures during hospitalization for systemic lupus erythematosus are shown. GI: gastrointestinal; CT: computed tomography; MRI: magnetic resonance imaging; EEG: electroencephalography. B. Temporal trends for the 5 most commonly billed hospital procedures (comprising over 40% of all procedures) are shown. The associated p values for trend are medication infusion (p = 0.20), dialysis (p = 0.01), blood transfusion (p < 0.001), vascular catheterization (p = 0.002), and renal biopsy (p = 0.74).
Tables
n = 26,903 for All Years n (%) Patient-specific factors Age, yrs 2–12 2337 (8.7) 12–17 12,379 (46.0) 18–20 12,187 (45.3) Female* 22,814 (84.8) Race/ethnicity* White 5140 (19.1) Black 8853 (32.9) Hispanic 5902 (21.9) Other 2733 (10.2) Primary payer* Medicaid 12,268 (45.6) Private 10,411 (38.7) Other 4171 (15.5) SLE nephritis No 11,705 (43.5) Yes 15,198 (56.5) Hospital-specific factors Location* Urban 24,858 (92.4) Rural 1025 (3.8) Region Northeast 5165 (19.2) Midwest 4246 (15.8) South 10,478 (38.9) West 7014 (26.1) Teaching status* Teaching 20,608 (76.6) Non-teaching 5281 (19.6) Type* Children’s Hospital 14,958 (55.6) General Hospital 9990 (37.1) -
↵* The percentages for these categories do not add up to 100% because of missing demographic data, as follows: sex 0.3%, race/ethnicity 15.9%, primary payer 0.2%, location 3.8%, teaching status 3.8%, hospital type 7.3%. SLE: systemic lupus erythematosus.
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Year Discharges, n (95% CI) Hospitalization Rate* (95% CI) Mortality, % (95% CI) Mean LOS, days (95% CI) All yrs 26,903 (23,802–30,005) 8.6 (7.6–9.6) 1.0 (0.8–1.1) 5.9 (5.6–6.2) 2000 5962 (5096–6827) 7.7 (6.6–8.8) 1.0 (0.7–1.4) 5.6 (5.2–6.1) 2003 6701 (5844–7559) 8.6 (7.6–9.7) 1.2 (0.8–1.5) 6.1 (5.7–6.5) 2006 7344 (6416–8273) 9.3 (8.2–10.5) 1.2 (0.9–1.5) 6.3 (5.8–6.8) 2009 6896 (6021–7770) 8.7 (7.6–9.7) 0.6 (0.4–0.8) 5.7 (5.3–6.0) p value for trend** — 0.14 0.04 0.45 -
↵* SLE hospitalizations per 100,000 children in population aged 2 to 21 years, based on population estimates from US Census data.
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↵** Outcomes evaluated for temporal trend using multivariable regression to adjust for patient and hospital-specific demographic variables (with the exception of hospitalization rate, which was evaluated by univariable regression). SLE: systemic lupus erythematosus; LOS: length of stay.
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Risk Factor Mortality, OR (95% CI) LOS, RR (95% CI) Nephritis No — — Yes 2.71 (1.74–4.23)*** 1.30 (1.21–1.40)*** Age, yrs 2–12 — — 12–17 1.42 (0.58–3.48) 0.92 (0.81–1.04) 18–20 2.85 (1.21–6.71)* 1.06 (0.93–1.20) Sex Female — — Male 1.51 (0.99–2.29) 1.03 (0.94–1.14) Race White — — Black 2.01 (1.12–3.62)* 1.09 (1.00–1.20) Hispanic 1.39 (0.73–2.64) 1.07 (0.97–1.18) Other 1.88 (0.94–3.75) 1.14 (1.001–1.30)* Payer Medicaid — — Private 0.89 (0.59–1.34) 0.88 (0.82–0.94)*** Other 1.01 (0.65–1.58) 0.90 (0.82–0.999)* Location Rural — — Urban 0.98 (0.28–3.42) 1.33 (1.16–1.53)*** Region Northeast — — Midwest 0.81 (0.34–1.95) 1.08 (0.92–1.28) South 2.03 (1.23–3.36)** 1.06 (0.92–1.21) West 1.77 (0.98–3.20) 1.11 (0.93–1.32) Teaching No — — Yes 1.06 (0.60–1.87) 1.10 (1.01–1.20)* Type General — — Children’s 0.95 (0.59–1.52) 1.05 (0.95–1.17) -
Shown are OR and relative risks (RR) for risk factors included in the multivariable regressions for the main outcomes. The covariates included in the multivariable regressions were calendar year, presence of SLE nephritis, age group, sex, race/ethnicity, primary payer, hospital location, hospital region, hospital teaching status, and hospital type. Reference groups are denoted by “—”. Significance for p values is
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↵* p < 0.05,
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↵** p < 0.01,
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↵*** p < 0.001. SLE: systemic lupus erythematosus; LOS: length of stay.
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- APPENDIX 1.
ICD-9-CM codes used to define SLE nephritis. SLE diagnosis with ICD-9-CM = 710.0 in any position, plus one of the following codes in any position.
ICD-9-CM Diagnosis Codes Nephritis 580.0, 580.4, 580.8, 580.81, 580.89, 580.9, 581.0, 581.1, 581.2, 581.3, 581.8, 581.81, 581.89, 581.9, 582.0, 582.1, 582.2, 582.4, 582.8, 582.81, 582.89, 582.9, 583.0, 583.1, 583.2, 583.4, 583.6, 583.7, 583.8, 583.81, 583.89, 583.9 Chronic kidney disease 585, 585.1, 585.2, 585.3, 585.4, 283.11, 403.00, 403.10, 403.90, 404.00, 404.10, 404.90, 404.01, 404.11, 404.91, 587, 588.8, 588.9, 642.1, 642.2, 794.4 Dialysis v56.0, v56.8, v45.11, v56.1, v56.2, v56.3, v45.12, 792.5, v45.1, v56.31, v56.32 Kidney transplant v42.0, 996.81 Acute kidney failure 584, 584.5, 584.6, 584.7, 584.8, 584.9 Endstage kidney disease 585.5, 585.6, 585.9, 586, 403.01, 403.11, 403.91, 404.02, 404.12, 404.92, 404.03, 404.13, 404.93 ICD-9-CM Procedure Codes Dialysis 39.95, 54.98, 39.93, 39.94, 39.42, 39.27 Kidney transplant 55.69, 55.53, 55.52, 55.51, 55.54 Kidney biopsy 55.23, 55.24, 55.39, 55.21 -
ICD-9-CM: International Classification of Diseases, 9th revision, clinical modification; SLE: systemic lupus erythematosus.
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Procedure Category ICD-9-CM Procedure Codes Medication infusion 9971, 9929, 9928, 9923, 9925, 9921, 9914, 9918, 9919, 9910 Dialysis 5498, 3995, 3994, 3993, 3942, 3927 Blood transfusion 9900–9909 Vascular catheterization 3891, 3892, 3893 Renal biopsy 5523, 5524 Diagnostic ultrasound 8872, 8873, 8875, 8877–8879, 0023 Obstetric procedures 740–742, 7499, 7301, 7309, 731, 734, 7351, 7359, 7531–7535, 7538, 7550–7552, 7561, 7562, 7569 Intubation/ventilation 9390, 9604, 9671, 9672 Spinal tap 331 GI endoscopy/biopsy 4223, 4224, 4414, 4513, 4514, 4516, 4523–4525 CT scan 8703, 8741, 8801, 8771 0031, 8838 Pericardiocardial/thoracic/abdominal centesis 3404, 3409, 3491, 370, 5491 MRI 8891–8895, 8897 Angiography 8851, 8849, 8847, 8843, 8841, 8852–8857, 3721–3723 Physical/occupational therapy 9339, 9322, 9311, 9383, 9381, 9375 Bone marrow biopsy 4131 Bronchoscopy 3322–3324, 3326, 3327 Enteral/parenteral nutrition 966, 9915 Plasmapheresis 9971–9974 EEG 8914 -
ICD-9-CM: International Classification of Diseases, 9th revision, clinical modification; GI: gastrointestinal; CT: computed tomography; MRI: magnetic resonance imaging; EEG: electroencephalography.
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