Inpatient Burden and Mortality of Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014

Wisit Kaewput; Charat Thongprayoon; Boonphiphop Boonpheng; Patompong Ungprasert; Tarun Bathini; Api Chewcharat; Narat Srivali; Saraschandra Vallabhajosyula; Wisit Cheungpasitporn

doi:10.3390/jcm9020455

Inpatient Burden and Mortality of Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014

J Clin Med. 2020 Feb 6;9(2):455. doi: 10.3390/jcm9020455.

Authors

Wisit Kaewput¹, Charat Thongprayoon², Boonphiphop Boonpheng³, Patompong Ungprasert⁴, Tarun Bathini⁵, Api Chewcharat², Narat Srivali⁶, Saraschandra Vallabhajosyula⁷, Wisit Cheungpasitporn⁸

Affiliations

¹ Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
² Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
³ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
⁴ Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
⁵ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
⁶ Department of Internal Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA.
⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
⁸ Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.

Abstract

Background: Goodpasture's syndrome is a rare, life-threatening, small vessel vasculitis. Given its rarity, data on its inpatient burden and resource utilization are lacking. We conducted this study aiming to assess inpatient prevalence, mortality, and resource utilization of Goodpasture's syndrome in the United States. Methods: The 2003-2014 National Inpatient Sample was used to identify patients with a principal diagnosis of Goodpasture's syndrome. The inpatient prevalence, clinical characteristics, in-hospital treatment, end-organ failure, mortality, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 964 patients were admitted in hospital with Goodpasture's syndrome as the principal diagnosis, accounting for an overall inpatient prevalence of Goodpasture's syndrome among hospitalized patients in the United States of 10.3 cases per 1,000,000 admissions. The mean age of patients was 54 ± 21 years, and 47% were female; 52% required renal replacement therapy, whereas 39% received plasmapheresis during hospitalization. Furthermore, 78% had end-organ failure, with renal failure and respiratory failure being the two most common end-organ failures. The in-hospital mortality rate was 7.7 per 100 admissions. The factors associated with increased in-hospital mortality were age older than 70 years, sepsis, the development of respiratory failure, circulatory failure, renal failure, and liver failure, whereas the factors associated with decreased in-hospital mortality were more recent year of hospitalization and the use of therapeutic plasmapheresis. The median length of hospital stay was 10 days. The median hospitalization cost was $75,831. Conclusion: The inpatient prevalence of Goodpasture's syndrome in the United States is 10.3 cases per 1,000,000 admissions. Hospitalization of patients with Goodpasture's syndrome was associated with high hospital inpatient utilization and costs.

Keywords: Goodpasture syndrome; anti-GBM disease; epidemiology; hospitalization; outcomes.