title: A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis.
abstract: OBJECTIVE
  Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM.
  
  
  METHODS
  Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population.
  
  
  RESULTS
  A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6).
  
  
  CONCLUSIONS
  Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.
authors.affiliation: University of California, San Francisco.
authors.forename: Sara G
authors.initials: SG
authors.lastname: Murray
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Erica
authors.initials: E
authors.lastname: Lawson
authors.forename: Matthew
authors.initials: M
authors.lastname: Cascino
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barton
authors.forename: Mary
authors.initials: M
authors.lastname: Margaretten
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D016208:Databases, Factual; D003882:Dermatomyositis / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000401:mortality*; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000175:diagnosis / Q000401:mortality*; D063886:Patient Discharge Summaries; D017285:Polymyositis / Q000175:diagnosis / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology