J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 8, August 2020, pages 508-516

The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study

Figure 1. Temporal trends of risk-adjusted short-term mortality among ICU admissions of patients with SLE with and without mental disorders. Short-term mortality is defined as that of hospitalizations with in-hospital death or discharge to hospice. Hospitalizations with mental disorders are represented by diamond markers (blue) and those without mental disorders are represented by box markers (orange). AAPC (95% CI) denotes average annual percent change and its 95% confidence interval. Short-term mortality estimates were adjusted for age, gender, race/ethnicity, health insurance, Deyo comorbidity index, chronic lung disease, congestive heart failure, cerebrovascular disease, chronic renal disease, diabetes, malignancy, liver disease, transfer from another hospital, number of organ failures, and year of admission. ICU: intensive care unit; SLE: systemic lupus erythematosus.

**Table 1.** The Characteristics of ICU Admissions With SLE With and Without Mental Disorders
Variables	Mental disorders^a (n = 13,238)	No mental disorders^a (n = 21,753)	P
^aPercentage figures may not add to 100 due to rounding. ^bGender was reported for 11,087 ICU admissions with mental disorders and for 21,691 ICU admissions without mental disorders; the percent figures for gender in each column refer to that column’s denominator for gender. ^cMean (standard deviation (SD)). ICU: intensive care unit; SLE: systemic lupus erythematosus; IQR: interquartile range.
Age, years (%)			< 0.0001
18 - 44	4,347 (32.8)	8,667 (39.8)
45 - 64	5,770 (43.6)	8,420 (38.7)
≥ 65	3,121 (23.6)	4,666 (21.4)
Gender^b
Female	9,984 (90.1)	19,236 (88.7)	0.0002
Race/ethnicity (%)			< 0.0001
White	6,119 (46.2)	7,230 (33.2)
Hispanic	2,772 (20.9)	6,154 (28.3)
Black	3,561 (26.9)	6,843 (31.5)
Other	786 (5.9)	1,526 (7.0)
Health insurance (%)			< 0.0001
Private	4,290 (32.4)	7,506 (34.5)
Medicare	5,994 (45.3)	9,266 (42.6)
Medicaid	1,640 (12.4)	2,630 (12.1)
Uninsured	1,178 (8.9)	2,089 (9.6)
Other	130 (1.0)	248 (1.1)
Missing	6 (< 0.1)	14 (< 0.1)
Deyo comorbidity index^c	2.60 (1.77)	2.55 (1.73)	0.036
Selected comorbidities (%)
Chronic lung disease	4,392 (33.2)	5,416 (24.9)	< 0.0001
Congestive heart failure	3,192 (24.1)	5,285 (24.3)	0.70331
Cerebrovascular disease	1,303 (9.8)	1,904 (8.8)	0.0006
Renal disease	3,856 (29.1)	8,565 (39.4)	< 0.0001
Diabetes	3,222 (24.3)	5,074 (23.3)	0.0312
Malignancy	536 (4.0)	791 (3.6)	0.0513
Liver disease	1,006 (7.6)	1,481 (6.8)	0.0053
Transfer from another hospital (%)	762 (5.8)	1,340 (6.2)	0.1175
Teaching hospital (%)	3,781 (28.6)	6,351 (29.2)	0.2076
Number of organ dysfunctions^c	0.93 (1.07)	1.04 (1.12)	< 0.0001
Type of organ dysfunctions (%)
Respiratory	2,340 (17.7)	3,619 (16.6)	0.0121
Cardiovascular	1,193 (9.0)	1,904 (8.8)	0.4062
Renal	5,023 (37.9)	10,447 (48.0)	< 0.0001
Hepatic	241 (1.8)	464 (2.1)	0.0452
Hematological	1,375 (10.4)	2,936 (13.5)	< 0.0001
Neurological	1,114 (8.4)	1,247 (5.7)	< 0.0001
Mechanical ventilation (%)	1,322 (10.0)	2,123 (9.8)	0.4836
Hemodialysis (%)	1,744 (13.2)	4,362 (20.1)	< 0.0001
Hospital length of stay
Mean (SD)	7.3 (8.6)	7.2 (8.4)
Median (IQR)	5 (3 - 9)	5 (3 - 8)	0.0001
Hospital charges
Mean (SD)	78,766 (106,145)	80,192 (108,417)
Median (IQR)	47,491 (27,455 - 90,238)	47,118 (26,445 - 91,195)	0.1222
Hospital disposition (%)
Death	406 (3.1)	990 (4.6)	< 0.0001
Hospice	226 (1.7)	275 (1.3)	0.0008
Home	9,640 (72.8)	17,034 (78.3)	< 0.0001
Another hospital	1,417 (10.7)	1,904 (8.8)	< 0.0001
Nursing facility	1,244 (9.4)	1,203 (5.5)	< 0.0001
Leave against medical advice	242 (1.9)	274 (1.3)	< 0.0001

Table 1. The Characteristics of ICU Admissions With SLE With and Without Mental Disorders

Variables

Mental disorders^a (n = 13,238)

No mental disorders^a (n = 21,753)

^aPercentage figures may not add to 100 due to rounding. ^bGender was reported for 11,087 ICU admissions with mental disorders and for 21,691 ICU admissions without mental disorders; the percent figures for gender in each column refer to that column’s denominator for gender. ^cMean (standard deviation (SD)). ICU: intensive care unit; SLE: systemic lupus erythematosus; IQR: interquartile range.

Age, years (%)

< 0.0001

18 - 44

4,347 (32.8)

8,667 (39.8)

45 - 64

5,770 (43.6)

8,420 (38.7)

≥ 65

3,121 (23.6)

4,666 (21.4)

Gender^b

Female

9,984 (90.1)

19,236 (88.7)

0.0002

Race/ethnicity (%)

< 0.0001

White

6,119 (46.2)

7,230 (33.2)

Hispanic

2,772 (20.9)

6,154 (28.3)

Black

3,561 (26.9)

6,843 (31.5)

Other

786 (5.9)

1,526 (7.0)

Health insurance (%)

< 0.0001

Private

4,290 (32.4)

7,506 (34.5)

Medicare

5,994 (45.3)

9,266 (42.6)

Medicaid

1,640 (12.4)

2,630 (12.1)

Uninsured

1,178 (8.9)

2,089 (9.6)

Other

130 (1.0)

248 (1.1)

Missing

6 (< 0.1)

14 (< 0.1)

Deyo comorbidity index^c

2.60 (1.77)

2.55 (1.73)

0.036

Selected comorbidities (%)

Chronic lung disease

4,392 (33.2)

5,416 (24.9)

< 0.0001

Congestive heart failure

3,192 (24.1)

5,285 (24.3)

0.70331

Cerebrovascular disease

1,303 (9.8)

1,904 (8.8)

0.0006

Renal disease

3,856 (29.1)

8,565 (39.4)

< 0.0001

Diabetes

3,222 (24.3)

5,074 (23.3)

0.0312

Malignancy

536 (4.0)

791 (3.6)

0.0513

Liver disease

1,006 (7.6)

1,481 (6.8)

0.0053

Transfer from another hospital (%)

762 (5.8)

1,340 (6.2)

0.1175

Teaching hospital (%)

3,781 (28.6)

6,351 (29.2)

0.2076

Number of organ dysfunctions^c

0.93 (1.07)

1.04 (1.12)

< 0.0001

Type of organ dysfunctions (%)

Respiratory

2,340 (17.7)

3,619 (16.6)

0.0121

Cardiovascular

1,193 (9.0)

1,904 (8.8)

0.4062

Renal

5,023 (37.9)

10,447 (48.0)

< 0.0001

Hepatic

241 (1.8)

464 (2.1)

0.0452

Hematological

1,375 (10.4)

2,936 (13.5)

< 0.0001

Neurological

1,114 (8.4)

1,247 (5.7)

< 0.0001

Mechanical ventilation (%)

1,322 (10.0)

2,123 (9.8)

0.4836

Hemodialysis (%)

1,744 (13.2)

4,362 (20.1)

< 0.0001

Hospital length of stay

Mean (SD)

7.3 (8.6)

7.2 (8.4)

Median (IQR)

5 (3 - 9)

5 (3 - 8)

0.0001

Hospital charges

Mean (SD)

78,766 (106,145)

80,192 (108,417)

Median (IQR)

47,491 (27,455 - 90,238)

47,118 (26,445 - 91,195)

0.1222

Hospital disposition (%)

Death

406 (3.1)

990 (4.6)

< 0.0001

Hospice

226 (1.7)

275 (1.3)

0.0008

Home

9,640 (72.8)

17,034 (78.3)

< 0.0001

Another hospital

1,417 (10.7)

1,904 (8.8)

< 0.0001

Nursing facility

1,244 (9.4)

1,203 (5.5)

< 0.0001

Leave against medical advice

242 (1.9)

274 (1.3)

< 0.0001

**Table 2.** Univariate and Multivariate Logistic Regression Analysis of Predictors of Short-Term Mortality Among All ICU Admissions With SLE
Variables	Unadjusted odds ratio (95% CI)	P	Adjusted odds ratio (95% CI)	P
ICU: intensive care unit; SLE: systemic lupus erythematosus; 95% CI: 95% confidence interval.
Age (years)
18 - 44	Reference		Reference
45 - 64	1.97 (1.74 - 2.23)	< 0.0001	1.82 (1.56 - 2.11)	< 0.0001
≥ 65	3.52 (3.10 - 4.00)	< 0.0001	3.11 (2.62 - 3.68)	< 0.0001
Gender
Male	Reference
Female	0.66 (0.58 - 0.75)	< 0.0001	0.81 (0.69 - 0.95)	0.0105
Race/ethnicity
White	Reference		Reference
Hispanic	0.81 (0.72 - 0.91)	0.0005	NA
Black	0.72 (0.64 - 0.81)	< 0.0001	0.87 (0.77 - 0.99)	0.0467
Other	1.01 (0.84 - 1.21)	0.8773	NA
Health insurance
Private	Reference		Reference
Medicare	1.54 (1.39 - 1.72)	< 0.0001	1.23 (1.08 - 1.41)	0.0015
Medicaid	0.91 (0.76 - 1.08)	0.2921	NA
No insurance	1.06 (0.88 - 1.28)	0.4874	NA
Other	0.70 (0.39 - 1.25)	0.234	NA
Deyo comorbidity index	1.33 (1.31 - 1.36)	< 0.0001	1.20 (1.15 - 1.24)	< 0.0001
Chronic lung disease	1.25 (1.13 - 1.38)	< 0.0001	NA
Congestive heart failure	1.88 (1.71 - 2.07)	< 0.0001	1.83 (1.72 - 1.96)	0.0012
Cerebrovascular disease	1.93 (1.69 - 2.20)	< 0.0001	1.75 (1.50 - 2.05)	< 0.0001
Renal disease	1.33 (1.21 - 1.46)	< 0.0001	1.51 (1.45 - 1.58)	< 0.0001
Malignancy	3.41 (2.89 - 4.01)	< 0.0001	1.71 (1.33 - 2.20)	< 0.0001
Liver disease	3.81 (3.38 - 4.31)	< 0.0001	1.70 (1.56 - 1.86)	0.0011
Mental disorders	0.81 (0.73 - 0.89)	< 0.0001	0.82 (0.73 - 0.93)	0.0016
Emergent admission	0.86 (0.78 - 0.95)	0.0053	NA
Transfer from another hospital	2.52 (2.18 - 2.90)	< 0.0001	1.79 (1.51 - 2.12)	< 0.0001
Teaching hospital	1.21 (1.09 - 1.33)	0.0001	NA
Number of organ dysfunctions	2.71 (2.61 - 2.81)	< 0.0001	2.81 (2.69 - 2.93)	< 0.0001
Year of admission	1.03 (1.00 - 1.06)	0.0132	1.02 (1.00 - 1.07)	0.018

Table 2. Univariate and Multivariate Logistic Regression Analysis of Predictors of Short-Term Mortality Among All ICU Admissions With SLE

Variables

Unadjusted odds ratio (95% CI)

Adjusted odds ratio (95% CI)

ICU: intensive care unit; SLE: systemic lupus erythematosus; 95% CI: 95% confidence interval.

Age (years)

18 - 44

Reference

45 - 64

1.97 (1.74 - 2.23)

< 0.0001

1.82 (1.56 - 2.11)

< 0.0001

≥ 65

3.52 (3.10 - 4.00)

< 0.0001

3.11 (2.62 - 3.68)

< 0.0001

Gender

Male

Reference

Female

0.66 (0.58 - 0.75)

< 0.0001

0.81 (0.69 - 0.95)

0.0105

Race/ethnicity

White

Reference

Hispanic

0.81 (0.72 - 0.91)

0.0005

Black

0.72 (0.64 - 0.81)

< 0.0001

0.87 (0.77 - 0.99)

0.0467

Other

1.01 (0.84 - 1.21)

0.8773

Health insurance

Private

Reference

Medicare

1.54 (1.39 - 1.72)

< 0.0001

1.23 (1.08 - 1.41)

0.0015

Medicaid

0.91 (0.76 - 1.08)

0.2921

No insurance

1.06 (0.88 - 1.28)

0.4874

Other

0.70 (0.39 - 1.25)

0.234

Deyo comorbidity index

1.33 (1.31 - 1.36)

< 0.0001

1.20 (1.15 - 1.24)

< 0.0001

Chronic lung disease

1.25 (1.13 - 1.38)

< 0.0001

Congestive heart failure

1.88 (1.71 - 2.07)

< 0.0001

1.83 (1.72 - 1.96)

0.0012

Cerebrovascular disease

1.93 (1.69 - 2.20)

< 0.0001

1.75 (1.50 - 2.05)

< 0.0001

Renal disease

1.33 (1.21 - 1.46)

< 0.0001

1.51 (1.45 - 1.58)

< 0.0001

Malignancy

3.41 (2.89 - 4.01)

< 0.0001

1.71 (1.33 - 2.20)

< 0.0001

Liver disease

3.81 (3.38 - 4.31)

< 0.0001

1.70 (1.56 - 1.86)

0.0011

Mental disorders

0.81 (0.73 - 0.89)

< 0.0001

0.82 (0.73 - 0.93)

0.0016

Emergent admission

0.86 (0.78 - 0.95)

0.0053

Transfer from another hospital

2.52 (2.18 - 2.90)

< 0.0001

1.79 (1.51 - 2.12)

< 0.0001

Teaching hospital

1.21 (1.09 - 1.33)

0.0001

Number of organ dysfunctions

2.71 (2.61 - 2.81)

< 0.0001

2.81 (2.69 - 2.93)

< 0.0001

Year of admission

1.03 (1.00 - 1.06)

0.0132

1.02 (1.00 - 1.07)

0.018