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Lung involvement in systemic sclerosis is associated with adverse hospital outcomes: insights from the National Inpatient Sample
  1. Jesse Osemudiamen Odion1,
  2. Armaan Guraya2,
  3. Chukwudi Charles Muojieje3,
  4. Osahon Nekpen Idolor4,
  5. Eseosa Jennifer Sanwo4,
  6. Osaigbokan Paul Aihie5
  1. 1Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo, Nigeria
  2. 2Midwestern University Chicago College of Osteopathic Medicine, Chicago, Illinois, USA
  3. 3Department of Internal Medicine, Mountain View Regional Medical Center, Las Cruces, New Mexico, USA
  4. 4College of Medicine, University of Benin School of Medicine, Benin, Edo, Nigeria
  5. 5University of Missouri School of Medicine, Columbia, Missouri, USA
  1. Correspondence to Dr Jesse Osemudiamen Odion, Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo, Nigeria; jesse.odion123{at}


This study aimed to compare outcomes of systemic sclerosis (SSc) hospitalizations with and without lung involvement. The primary outcome was inpatient mortality while secondary outcomes were hospital length of stay (LOS) and total hospital charge. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. This database is the largest collection of inpatient hospitalization data in the USA. The NIS was searched for SSc hospitalizations with and without lung involvement as principal or secondary diagnosis using International Classification of Diseases 10th Revision (ICD-10) codes. SSc hospitalizations for patients aged ≥18 years from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for possible confounders for the primary and secondary outcomes, respectively. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 62,930 hospitalizations were for adult patients who had either a principal or secondary ICD-10 code for SSc. 5095 (8.10%) of these hospitalizations had lung involvement. Lung involvement group had greater inpatient mortality (9.04% vs 4.36%, adjusted OR 2.09, 95% CI 1.61 to 2.73, p<0.0001), increase in mean adjusted LOS of 1.81 days (95% CI 0.98 to 2.64, p<0.0001), and increase in mean adjusted total hospital charge of $31,807 (95% CI 14,779 to 48,834, p<0.0001), compared with those without lung involvement. Hospitalizations for SSc with lung involvement have increased inpatient mortality, LOS and total hospital charge compared with those without lung involvement. Collaboration between the pulmonologist and the rheumatologist is important in optimizing outcomes of SSc hospitalizations with lung involvement.

  • inpatients
  • scleroderma
  • systemic
  • death
  • hospital charges
  • hospitals

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  • Correction notice Since Online First publication, author name 'Chukwudi Charles Modijeje' has been corrected to 'Chukwudi Charles Muojieje'.

  • Contributors JOO and AG are credited with substantial contribution to the design of the work, acquisition and interpretation of data, and drafting of the manuscript. CCM and ONI are credited with substantial contribution to acquisition, analysis, and interpretation of data. JOO, AG, CCM, ONI, EJS and OPA are credited with revision of critically important intellectual content, final approval of the version to be published, and agreement of accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval National Inpatient Sample contains public deidentified patient data, hence institutional review board approval was waived for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. National Inpatient Sample is available online at

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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