title: Inpatient complications in patients with giant cell arteritis: decreased mortality and increased risk of thromboembolism, delirium and adrenal insufficiency.
abstract: OBJECTIVE
  The morbidity and mortality of hospitalized GCA patients have been unexplored. The aim of this study was to analyse inpatient complications experienced by patients with GCA.
  
  
  METHODS
  We used the Nationwide Inpatient Sample database to study a large group of patients admitted for pneumonia, myocardial infarction (MI), ischaemic stroke and femoral neck fracture. Patients were divided into two groups based on whether or not they had a diagnosis of GCA upon admission. Outcomes evaluated included inpatient mortality and the occurrence of adrenal insufficiency, deep vein thrombosis, pulmonary embolism and delirium.
  
  
  RESULTS
  From 2008 to 2011, 8 203 447 patients ≥50 years of age were discharged from US hospitals after admission with pneumonia, MI, stroke and femoral neck fracture. Among these patients, 9311 (0.11%) had GCA. Admissions for pneumonia, stroke and hip fracture were more frequent in GCA patients compared with those without GCA, accounting for 41.5% vs 39.4%, 24.9% vs 19.8% and 15.4% vs 14.2% of hospitalizations, respectively (P ≤ 0.001). Admissions for MI were more common in non-GCA patients (26.6% vs 18.2%, P < 0.001). During hospitalization, 4.1% of the GCA patients died, compared with 4.8% of those without GCA [odds ratio (OR) 0.73, P < 0.001). The GCA population suffered significantly more often from deep vein thrombosis (OR 2.08, P < 0.001), pulmonary embolism (OR 1.58, P < 0.001), delirium (OR 1.60, P < 0.001) and adrenal insufficiency (OR 4.95, P < 0.001).
  
  
  CONCLUSIONS
  Hospitalized GCA patients have lower mortality compared with the general inpatient population but greater risk of venous thromboembolism, delirium and adrenal insufficiency.
authors: Division of Rheumatology, Allergy and Immunology Division and sunizony@mgh.harvard.org.
authors: Sebastian
authors: S
authors: Unizony
authors: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Mariano E
authors: ME
authors: Menendez
authors: Division of Rheumatology, Allergy and Immunology Division and.
authors: Naina
authors: N
authors: Rastalsky
authors: Division of Rheumatology, Allergy and Immunology Division and.
authors: John H
authors: JH
authors: Stone
mesh_terms: D000309:Adrenal Insufficiency / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D019838:Neck Injuries / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D013923:Thromboembolism / Q000453:epidemiology*
keywords: GCA; adrenal insufficiency; deep vein thrombosis; delirium; mortality; pulmonary embolism; thrombophilia; vasculitis; venous thromboembolism