{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:21:13Z","timestamp":1786616473784,"version":"build-2736575974"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Importance<\/jats:title>\n Dermatomyositis (DM) is associated with increased rates of hospitalization and mortality. However, characteristics present at the time of admission that are associated with in-hospital mortality remain poorly defined in the US.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether features of DM present at admission, including active rash and muscle disease, interstitial lung disease (ILD), elevated neutrophil to lymphocyte ratio (NLR), myositis-specific autoantibody status, and baseline treatment regimens, are associated with in-hospital mortality among patients admitted with DM.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study included adults with pre-existing DM (confirmed by documentation by a dermatologist or rheumatologist) who were admitted for any cause at a single tertiary referral center from January 2013 to May 2024. Data were analyzed from August 2024 to August 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Clinical, serologic, and laboratory features of DM at the time of admission as well as baseline treatment prior to hospitalization.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was in-hospital mortality. Statistical analyses included descriptive statistics and multivariable logistic regression with the Firth correction, adjusting for demographics and DM subtype. Bonferroni correction was applied to control for multiple comparisons.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 153 patients with DM (113 females [73.9%]; mean [SD] age, 56.5 [14.3] years), 16 (10.5%) died during hospitalization. Deceased patients were more likely than survivors to have active rash (13 of 16 [81.3%] vs 47 of 137 [34.3%]), ILD (14 of 16 [87.5%] vs 57 of 137 [41.6%]), and elevated NLR (mean [SD], 12.5 [7.43] vs 4.90 [3.82]). Myositis prevalence did not differ significantly between deceased patients and survivors. In multivariable analysis, active rash (odds ratio [OR], 12.13; 95% CI, 3.18-46.28;\n P<\/jats:italic>\n \u2009=\u2009.003), ILD (OR, 6.43; 95% CI, 1.78-23.13;\n P<\/jats:italic>\n \u2009=\u2009.04), and NLR (OR per 1-unit increase, 1.29 [95% CI, 1.16-1.44];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) were independently associated with mortality. No association with baseline intravenous immunoglobulin use was observed among patients who died after Bonferroni correction.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, active rash, ILD, and elevated NLR were independently associated with in-hospital mortality in patients with DM, regardless of disease subtype or myositis-specific autoantibody status. Recognizing these high-risk features may guide inpatient management and support future risk stratification strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2025.4161","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T15:33:59Z","timestamp":1761752039000},"page":"1252","source":"Crossref","is-referenced-by-count":2,"title":["Active Rash, Interstitial Lung Disease, and Neutrophil to Lymphocyte Ratio and Mortality in Dermatomyositis"],"prefix":"10.1001","volume":"161","author":[{"given":"Anjana","family":"Srikumar","sequence":"first","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kaltchenko","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keon","family":"Niknejad","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"McCaffrey","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"dbr250009r1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13671-023-00389-6","article-title":"Dermatomyositis diagnosis and treatment in the inpatient setting.","volume":"12","author":"Hejazi","year":"2023","journal-title":"Curr Dermatol Rep"},{"issue":"4","key":"dbr250009r2","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.jbspin.2020.03.002","article-title":"Inpatient burden and resource utilization of polymyositis and dermatomyositis: a 10-year Study of National Inpatient Sample.","volume":"87","author":"Ungprasert","year":"2020","journal-title":"Joint Bone Spine"},{"issue":"2","key":"dbr250009r3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192491","article-title":"Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: A retrospective case-control 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dermatomyositis","volume":"76","author":"Swaminathan","year":"2024","journal-title":"Arthritis Rheumatol"},{"issue":"2","key":"dbr250009r7","first-page":"246","article-title":"Predictors of mortality for dermatomyositis patients positive with anti-melanoma differentiation-related gene 5 and optimal treatment.","volume":"42","author":"Liu","year":"2024","journal-title":"Clin Exp Rheumatol"},{"issue":"9","key":"dbr250009r8","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1007\/s00296-013-2735-y","article-title":"Skin ulcer is a predictive and prognostic factor of acute or subacute interstitial lung disease in dermatomyositis.","volume":"33","author":"Ishigaki","year":"2013","journal-title":"Rheumatol Int"},{"issue":"1","key":"dbr250009r9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0190411","article-title":"Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study.","volume":"13","author":"Ha","year":"2018","journal-title":"PLoS One"},{"issue":"11","key":"dbr250009r10","doi-asserted-by":"publisher","first-page":"2941","DOI":"10.4049\/jimmunol.2000596","article-title":"The role of cutaneous type I IFNs in autoimmune and autoinflammatory diseases.","volume":"205","author":"Turnier","year":"2020","journal-title":"J Immunol"},{"issue":"1","key":"dbr250009r11","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2020-000382","article-title":"Neutrophil and lymphocyte counts are associated with different immunopathological mechanisms in systemic lupus erythematosus.","volume":"7","author":"Han","year":"2020","journal-title":"Lupus Sci Med"},{"issue":"8","key":"dbr250009r12","doi-asserted-by":"publisher","first-page":"4301","DOI":"10.3390\/ijms23084301","article-title":"Pathophysiological mechanisms and treatment of dermatomyositis and immune mediated necrotizing myopathies: a focused 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