GPA Patients Undergo More Hospitalizations With Worse Outcomes, US Study Finds

Patients with granulomatosis with polyangiitis, a subtype of ANCA-associated vasculitis (AAV), have a higher rate of hospitalizations than the general population, a U.S. study reports.

Their hospitalizations were also linked to higher morbidity, mortality, and costs.

The study, “Inpatient epidemiology and economic burden of granulomatosis with polyangiitis: a 10-year study of the national inpatient sample,” was published in the journal Rheumatology.

Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, causes necrotizing granulomatous vasculitis, or severe blood vessel inflammation. This condition affects multiple systems and organs including the lungs, kidneys, skin, upper respiratory tract, eyes, joints, and nervous system. Yet, this is a rare disease, with an estimated prevalence of one to 13 patients per million people.

“Due to the rarity of the disease, little is known about inpatient epidemiology and resource utilization of patients with GPA,” the investigators wrote.

To address these questions, researchers at the Cleveland Clinic in collaboration with colleagues at the Mayo Clinic and the University of Mississippi Medical Center used a large public database — the Nationwide Inpatient Sample (NIS) — to identify patients who had been diagnosed with GPA from 2005 to 2014.

The investigators used the NIS, which contains information from more than 4,000 hospitals in over 40 U.S. states, also to extract data from a group of patients without GPA to be used as controls.

The GPA patients included in the study had a mean age of 60.2 years, and more than half (52.3%) were women. Most were Caucasian (79.2%), followed by Hispanic (12.9%), and African-American (6.8%).

In total, 32.6 GPA cases were found per 100,000 hospital admissions. GPA itself (38.3%), pneumonia (13.7%), and sepsis (8.4%) were the most common reasons cited for these admissions.

Further analyses showed that hospitalizations in GPA patients were associated with higher morbidity and mortality, compared to those without GPA. In particular, those with GPA were found to have more than double the risk of acute kidney injuries or multi-organ failure compared to those who did not have the disease.

Additionally, the chances of going into shock or being admitted to the intensive care unit were also higher among GPA patients.

GPA patients spent an average 7.1 days in hospital (nearly two days longer than patients without GPA), and underwent computerized tomography scans and peripheral vascular interventions more frequently than those who did not have the disease.

The patients also paid more in hospital costs, with an additional mean of $5,125 for total costs, and an additional mean of $16,841 for total hospitalization charges when compared to those without GPA.

Overall, “the current study found that inpatient prevalence of GPA was higher than what would be expected from prevalence in the general population. Hospitalizations of patients with GPA were associated with higher morbidity, mortality and cost,” the researchers wrote.