The Epidemiology and Outcomes of Mental Disorders in Critically Ill Patients With Systemic Lupus Erythematosus: A Population-Based Study
Bibliographic record
Abstract
BACKGROUND: Hospitalized patients with systemic lupus erythematosus (SLE) often require critical care, and SLE is the most common autoimmune disease in the intensive care unit (ICU). Mental disorders are highly prevalent among patients with SLE and are associated with increased morbidity and premature death in this population. However, the association of mental disorders with ICU utilization among patients with SLE and their prognostic impact among those admitted to ICU is unknown. METHODS: We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File to identify SLE hospitalizations aged ≥ 18 years during 2009 - 2014. Mental disorders were defined by the taxonomy of the Healthcare Cost and Utilization Project's Clinical Classification Software Category 5. The patterns of ICU admission among SLE hospitalizations with and without mental disorders were examined. Multivariable logistic regression modeling was used to examine the association of mental disorders and short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions. RESULTS: Among 94,338 SLE hospitalizations 35,793 (37.9%) had mental disorders. There was no difference in the rates of ICU admission among SLE hospitalizations with and without mental disorders (37% vs. 37.2%, respectively; P = 0.5999), and similar rates of mental disorders were found among SLE hospitalizations with and without ICU admission (37.8% vs. 38%, respectively; P = 0.5408). The volume of SLE ICU admissions with and without mental disorders rose between 2009 and 2014 by 60.3% vs. 7.9%, respectively. When compared to those without mental disorders, SLE ICU admissions with mental disorders were older (age ≥ 65 years, 23.6% vs. 21.4%, respectively) and had higher burden of comorbid conditions. Unadjusted short-term mortality among SLE ICU admissions with and without mental disorders was 4.8% and 5.8%, respectively and mental disorders were associated with lower short-term mortality on adjusted analyses (adjusted odds ratio (aOR): 0.826; 95% confidence interval (CI): 0.734 - 0.930). CONCLUSIONS: There was no difference in the frequency of mental disorders among hospitalized patients with SLE with and without ICU admission. However, the growth in the volume of ICU admissions with SLE over time involved predominantly patients with mental disorders. Among ICU admissions, mental disorders were associated with lower short-term mortality.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".