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Sepsis, pneumonia leading causes of readmission in ANCA-associated vasculitis

Mukund Kumar

DESTIN, Fla. — Sepsis and pneumonia are among the leading causes of 30- and 90-day hospital readmission among patients with ANCA-associated vasculitis, possibly due to immunosuppressive treatment regimens, according to data presented at the North American Young Rheumatology Investigator Forum.

“Antineutrophil cytoplasmic antibody, or ANCA, vasculitis mainly affects small and medium vessels, and includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA),” Mukund Kumar, MBBS, of Creighton University Medical Center, Omaha, Nebraska, told attendees. “They present with a wide spectrum of clinical manifestations with ANCA as the common pathogenesis. Infections are the major cause of mortality in patients treated with immunosuppressive therapy, respiratory tract infection being the most common.”

To analyze hospital readmission rates among patients with ANCA-associated vasculitis, Kumar and colleagues studied information from the Nationwide Readmissions Database from 2015 and 2016. The researchers used the database to identify hospitalizations in which the primary diagnosis was ANCA-associated vasculitis. They then stratified these hospitalizations by the occurrence of either a 30- or 90-day all-cause readmission, using 2016 data only.

The researchers examined the most frequent primary diagnoses at readmission and used a multivariate logistic regression model to identify predictors of 30- and 90-day readmission. All analyses accommodated the Nationwide Readmissions Database’s sampling design, Kumar said. Regarding 30-day readmissions, the researchers identified 2,185 patients initially hospitalized with ANCA-associated vasculitis, of whom 340 were cases of readmission. In 90-day readmissions, there were 1,500 index hospitalizations of ANCA-associated vasculitis, with 297 associated with readmission.

According to the Kumar, the most common diagnoses at readmission, among the both the 30- and 90-day groups, were sepsis, acute kidney failure, pneumonia, congestive heart failure and the recurrence of ANCA vasculitis. End-stage renal disease was associated with 99.8% increased likelihood of 30-day readmissions (95% CI, 27.6-216.2).

In the 90-day group, each 1-year increase in age was associated with a 1.7% increase in the odds for readmission (95% CI, 0.1-3.2). In addition, a secondary diagnosis of chronic kidney disease at index hospitalization was associated with a 71.1% increase in the likelihood for readmission (95% CI, 9.4-167.5). Meanwhile, end-stage renal disease was associated a with 109.5% increased chance for readmission (95% CI, 22.5-258.2).

“ANCA vasculitis is a rare disease, however there are a lot of studies going on, and there have been a lot of advances in both awareness and treatment strategies,” Kumar said. “There have been a lot of trials for new medications. However, our major challenges at present are the increased risk of infection with immunosuppressive therapy, and the morbidity associated with ANCA-associated vasculitis.” – by Jason Laday

Reference:
Kumar M. Causes and predictors of 30-day and 90-day readmission rates for ANCA associated vasculitis insights from nationwide readmission database. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.

Disclosure: Kumar reports no relevant financial disclosures.

Mukund Kumar

DESTIN, Fla. — Sepsis and pneumonia are among the leading causes of 30- and 90-day hospital readmission among patients with ANCA-associated vasculitis, possibly due to immunosuppressive treatment regimens, according to data presented at the North American Young Rheumatology Investigator Forum.

“Antineutrophil cytoplasmic antibody, or ANCA, vasculitis mainly affects small and medium vessels, and includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA),” Mukund Kumar, MBBS, of Creighton University Medical Center, Omaha, Nebraska, told attendees. “They present with a wide spectrum of clinical manifestations with ANCA as the common pathogenesis. Infections are the major cause of mortality in patients treated with immunosuppressive therapy, respiratory tract infection being the most common.”

To analyze hospital readmission rates among patients with ANCA-associated vasculitis, Kumar and colleagues studied information from the Nationwide Readmissions Database from 2015 and 2016. The researchers used the database to identify hospitalizations in which the primary diagnosis was ANCA-associated vasculitis. They then stratified these hospitalizations by the occurrence of either a 30- or 90-day all-cause readmission, using 2016 data only.

The researchers examined the most frequent primary diagnoses at readmission and used a multivariate logistic regression model to identify predictors of 30- and 90-day readmission. All analyses accommodated the Nationwide Readmissions Database’s sampling design, Kumar said. Regarding 30-day readmissions, the researchers identified 2,185 patients initially hospitalized with ANCA-associated vasculitis, of whom 340 were cases of readmission. In 90-day readmissions, there were 1,500 index hospitalizations of ANCA-associated vasculitis, with 297 associated with readmission.

According to the Kumar, the most common diagnoses at readmission, among the both the 30- and 90-day groups, were sepsis, acute kidney failure, pneumonia, congestive heart failure and the recurrence of ANCA vasculitis. End-stage renal disease was associated with 99.8% increased likelihood of 30-day readmissions (95% CI, 27.6-216.2).

In the 90-day group, each 1-year increase in age was associated with a 1.7% increase in the odds for readmission (95% CI, 0.1-3.2). In addition, a secondary diagnosis of chronic kidney disease at index hospitalization was associated with a 71.1% increase in the likelihood for readmission (95% CI, 9.4-167.5). Meanwhile, end-stage renal disease was associated a with 109.5% increased chance for readmission (95% CI, 22.5-258.2).

“ANCA vasculitis is a rare disease, however there are a lot of studies going on, and there have been a lot of advances in both awareness and treatment strategies,” Kumar said. “There have been a lot of trials for new medications. However, our major challenges at present are the increased risk of infection with immunosuppressive therapy, and the morbidity associated with ANCA-associated vasculitis.” – by Jason Laday

Reference:
Kumar M. Causes and predictors of 30-day and 90-day readmission rates for ANCA associated vasculitis insights from nationwide readmission database. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.

Disclosure: Kumar reports no relevant financial disclosures.

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