Elevated ESR, certain comorbidities are tied with longer shingles hospitalizations

A new report suggests that certain comorbidities and laboratory findings—in addition to complications—can help predict which people with shingles are at risk of longer hospitalizations.

Shingles generally follows a self-limiting course, but a small percentage of patients require hospitalization.

According to the Centers for Disease Control and Prevention (CDC), approximately 1% to 4% of patients with shingles will end up in the hospital. The groups most likely to be hospitalized with shingles include the elderly and those with compromised immune systems, the CDC says.

Yet, while risk factors for hospitalization have been well-studied, the factors affecting length of hospital stay are less clear. In a new report in Health Science Reports, investigators from Iran’s Shiraz University of Medical Sciences sought to find out which factors—such as demographics, clinical features, comorbidities, medications, or laboratory findings—might be associated with longer hospital stays for herpes zoster (HZ).

“Hospitalization due to HZ represents a significant economic burden and considerably impacts patients’ quality of life,” explained corresponding author Yasamin Dehghan, MD, and colleagues.

The authors looked at 109 patients who were hospitalized for shingles during the course of a four-year period at a tertiary referral center in Iran. The cohort had a nearly equal distribution of men and women and a mean age of 56.9 years. Patients who had been vaccinated against shingles were excluded from the study. The most common treatment—given to three-quarters of patients—was intravenous acyclovir. The mean length of stay was 6.1 ± 5.2 days, the investigators found.

The most common comorbidities among the cohort were hypertension (38.5%), diabetes mellitus (24.8%), and cardiovascular disease (15.6%). However, the investigators found that pre-existing neurological conditions and renal conditions were most closely associated with a longer hospital stay. For instance, the mean length of stay for people with cardiovascular disease was 4.24 days, while the mean length of stay for people with chronic kidney disease was 9.00 days, the investigators found. Those with neurological disease had a mean length of stay of 9.29 days, they found.

The longest stays were associated with severe complications, including encephalitis and Ramsay Hunt Syndrome, which were associated with mean hospital stays of 19.30 and 14.60 days, respectively.

The investigators found that one laboratory value—elevated erythrocyte sedimentation rate (ESR)—was also tied with longer hospital stays (correlation of r = 0.304, p = 0.006). The correlation, however, did not extend to C-reactive protein values, the investigators said.

Dehghan and colleagues said their findings did not find a significant association between age or immunosuppression and length of hospital stay.

“This contrasts with previous reports where advanced age is a strong predictor of longer hospitalization, with some studies reporting a median LOS (length of stay) of 10 days for patients older than 74 years, a finding attributed to immunosenescence and a higher burden of comorbidities,” the authors explained.

The lack of a correlation might be due to the relatively young age of this study’s cohort, the authors said, or perhaps due to a “masking effect,” in which the presence of a severe complication is so powerfully linked with hospital stay that it overshadows the independent contribution of age.

Still, Dehghan and colleagues said their report should help clinicians better understand individual patient risk profiles.

“By quantifying key drivers of extended hospitalization, our results provide actionable evidence to optimize inpatient management protocols,” they said.

The investigators added, though, that the “most effective long-term strategy” for reducing the burden of herpes zoster is not risk-stratifying those with shingles but rather preventing shingles through vaccination.