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Nejatifar F, Mirbolouk N, Masooleh IS, Kazemnejad E, Ghavidel-Parsa B, Ghanbari AM, Zayeni H. Association between neutrophil/lymphocyte ratio and disease severity in scleroderma patients. Heliyon 2023; 9:e20576. [PMID: 37860553 PMCID: PMC10582306 DOI: 10.1016/j.heliyon.2023.e20576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Systemic sclerosis is a chronic and progressive connective tissue disease with various manifestation. Inflammatory status is developed in early stages and is followed by major organs' dysfunction. Disease severity is evaluated mostly through Medsger scale. There is not any single laboratory test to evaluate disease severity, although some hematologic can reflect disease severity. In this study, we evaluated the association between hematologic indices (specially Neutrophil/Lymphocyte ratio) and Medsger score of disease severity. Materials and methods One hundred and twenty-three patients along with the same number of healthy controls were enrolled in this study. Demographic information and past medical records were gathered in first appointment. Hematologic indices were calculated based on the laboratory findings and the association between these indices and Medsger score of disease severity was evaluated. Results One hundred and twenty-three patients with mean disease duration of 9.54 and mean Medsger score of 7.42 were investigated in this study. Neutrophil count, erythrocyte sedimentation rate, red cell distribution width and NLR were significantly higher and mean platelets volume was significantly lower in SSc patients in comparison to controls. NLR was significantly correlated with pulmonary and cardiac involvements and Monocyte/Lymphocyte ratio was significantly correlated with the involvement of joint and tendons. We showed that NLR is a predictive factor for the severity of systemic sclerosis. We also found a cut off Value of 1.9 for NLR as a predictor for disease severity in our patients. Conclusion Our study shows that SSc and its severity is associated with some hematologic indices like NLR, MLR, platelets and hemoglobin. These indices can also specifically predict the involvement of some organs.
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Affiliation(s)
- Fatemeh Nejatifar
- Hematology and Medical Oncology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Neda Mirbolouk
- Guilan Rheumatology Research Center, Department of Rheumatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Irandokht Shenavar Masooleh
- Guilan Rheumatology Research Center, Department of Rheumatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad
- Guilan Trauma Research Center, Department of Biostatistics and Epidemiology, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Banafsheh Ghavidel-Parsa
- Guilan Rheumatology Research Center, Department of Rheumatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Mohammad Ghanbari
- Student Research Committee, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Habib Zayeni
- Guilan Rheumatology Research Center, Department of Rheumatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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2
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Potera J, Manadan AM. Reasons for hospitalization and in-hospital mortality in adults with systemic sclerosis: Analysis of the National Inpatient Sample. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:189-196. [PMID: 36211208 PMCID: PMC9537709 DOI: 10.1177/23971983221083225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 10/03/2023]
Abstract
Objective Systemic sclerosis is an autoimmune condition with significant morbidity and mortality despite modern medical therapies. The goal of this investigation was to comprehensively analyze all reasons for hospitalization and in-hospital death of systemic sclerosis patients. Methods We conducted a retrospective analysis of the adult systemic sclerosis hospitalizations from the 2016-2018 National Inpatient Sample. We included patients with a primary or secondary diagnosis of systemic sclerosis and compared them to the group without the disease. The incidence of inpatient death and total hospitalization charges were recorded along with the most frequent principal diagnoses for systemic sclerosis hospitalizations and mortality categorized into subgroups. Results There were 94,515 adult systemic sclerosis hospitalizations recorded in the 2016-2018 National Inpatient Sample database. Systemic sclerosis patients had higher inpatient mortality compared to the non-systemic sclerosis group (4.5% vs 2.2%, respectively, p < 0.0001), were more likely to be female (84% vs 58%, p < 0.0001), had a longer mean length of stay (6.1 vs 4.7 days, p < 0.0001), and greater mean total hospital charges ($70,018 vs $53,556, p < 0.0001). Sepsis, unspecified organism (A41.9) was the most common principal diagnosis for both hospitalized and deceased systemic sclerosis patients. Cardiovascular diagnoses (21.9%) were the most common reasons for hospitalization and infectious (28%)-for in-hospital death. Conclusion Our analysis of the National Inpatient Sample database from 2016 to 2018 showed that infections and cardiovascular diseases were a significant cause of morbidity and mortality among hospitalized systemic sclerosis patients. Sepsis was the most frequent specific diagnosis for both hospitalization and inpatient deaths. These results stress the importance of early recognition of life-threatening infections in this patient population.
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Affiliation(s)
- Joanna Potera
- Internal Medicine Department, John H.
Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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3
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Li Z, Xu D, Jiang X, Li T, Su Y, Mu R. Anemia Is an Indicator for Worse Organ Damage Trajectories in Patients with Systemic Sclerosis: A Retrospective Study. J Clin Med 2022; 11:jcm11175013. [PMID: 36078943 PMCID: PMC9456668 DOI: 10.3390/jcm11175013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
It is important for clinicians to determine the risk of worsening trajectories in SSc patients. The Scleroderma Clinical Trials Consortium (SCTC) Damage Index (DI) has been developed to quantify organ damage and shows good capability for mortality and morbidity prediction in patients with SSc. This retrospective study aimed to describe the SCTC-DI in Chinese SSc patients and to find features predicting worse organ damage trajectories based on SCTC-DI. A total of 433 SSc patients who met the inclusion criteria in the Peking University Third Hospital (PKUTH-SSc) and People’s Hospital SSc cohort (PKUPH-SSc) were recruited for our study. Organ damage was relatively mild in our Chinese SSc cohort compared to other cohorts, with a mean SCTC-DI of 5.21 ± 4.60. We used both SCTC-DI ≥ 6 and ≥4 to define the high burden of organ damage and established two risk models by the LASSO algorithm, which revealed good identification of high organ damage burden (AUC = 0.689, 95% CI 0.636 to 0.742, p < 0.001 in SCTC-DI ≥ 6 model; AUC = 0.694, 95% CI 0.641 to 0.746, p < 0.001 in modified SCTC-DI ≥ 4 model). The anemia index at the baseline was included in these two models and was also independently related to organ damage progression (HR = 1.75, 95% CI 1.16 to 2.66, p = 0.008). In addition, the presence of an anti-Scl-70 autoantibody was also a predictor of progression (HR = 1.91, 95% CI 1.22 to 2.99, p = 0.005). In conclusion, anemia at the baseline was an important indicator for worse organ damage trajectories in SSc patients. We recommend using hemoglobin as a potential biomarker to evaluate organ damage in SSc patients.
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Affiliation(s)
- Zhaohua Li
- Department of Rheumatology and Immunology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Dan Xu
- Department of Rheumatology and Immunology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Xintong Jiang
- Department of Rheumatology and Immunology, Peking University People’s Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Ting Li
- Department of Rheumatology and Immunology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Yin Su
- Department of Rheumatology and Immunology, Peking University People’s Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing 100191, China
- Correspondence: ; Tel.: +86-1082266789
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4
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Emil NS, Vondenberg JA, Waters YM, Muruganandam M, Ariza-Hutchinson A, Patel RA, Nunez SE, Gibb JI, McElwee MK, Poole JL, O'Sullivan FX, Fields RA, Sibbitt WL. Systemic sclerosis in Native Americans of the American Southwest. Int J Rheum Dis 2022; 25:916-925. [PMID: 35699136 DOI: 10.1111/1756-185x.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Many indigenous non-Caucasian populations, including Native Americans, have been reported to have higher rates, distinct clinical phenotypes, increased complications, and greater severity of systemic sclerosis (SSc). However, little is known of SSc specifically in Native Americans of the American Southwest. This study compared the clinical and serologic manifestations and outcomes of SSc in Native Americans and non-Native Americans (non-Natives) of this region. METHODS This cross-sectional retrospective study included 137 SSc patients (109 [80%] were non-Native and 28 [20%] were Native Americans) followed over a mean of 11.5 ± 7.6 years. Participants were repetitively evaluated with medical history, physical examination, echocardiography, chest imaging, and serologic testing. Disease characteristics and outcomes were statistically compared between Native Americans and non-Native patients. RESULTS The estimated prevalence of SSc in Native Americans was 40.0 cases/100 000 vs 17.1 cases/100 000 for non-Natives (odds ratio 2.34, 95% confidence interval [CI] 1.55-3.55, P < .001). The cohorts were similar in terms age, age of onset, limited vs diffuse cutaneous SSc, telangiectasias, gastroesophageal reflux disease, Raynaud phenomenon, serologies, interstitial lung disease, pulmonary arterial hypertension, scleroderma renal crisis, cancer prevalence, and overall mortality (all P > .05). However, for Native Americans, mortality specifically from fatal infections was 3.94-fold that of non-Natives (hazard ratio 6.88, 95% CI 1.37-34.64; P < .001). CONCLUSION In Native Americans of the American Southwest, SSc is increased in prevalence but is phenotypically similar to SSc in non-Natives. However, mortality due specifically to infection is increased in Native Americans with SSc.
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Affiliation(s)
- N Suzanne Emil
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jaime A Vondenberg
- Department of Medicine, Rheumatology/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yvonne M Waters
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Maheswari Muruganandam
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Angie Ariza-Hutchinson
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Rosemina A Patel
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sharon E Nunez
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - James I Gibb
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Matthew K McElwee
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Janet L Poole
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Frank X O'Sullivan
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Roderick A Fields
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Wilmer L Sibbitt
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Caetano J, Batista F, Amaral MC, Oliveira S, Alves JD. Acute hospitalization in a cohort of patients with systemic sclerosis: a 10-year retrospective cohort study. Rheumatol Int 2021; 42:1393-1402. [PMID: 34480254 PMCID: PMC8415435 DOI: 10.1007/s00296-021-04983-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/28/2021] [Indexed: 11/27/2022]
Abstract
This study aimed at analysing the causes and predictors of acute hospitalization and mortality in a cohort of SSc. Retrospective analysis of all acute hospital admissions of SSc patients fulfilling the 2013 EULAR/ACR Classification Criteria, from a single-centre cohort of 95 patients, between 2010 and 2020. The total number of SSc patients registered in our hospital, in this period, was 123. Clinical data were collected from medical files of our institution and from the National Healthcare Registry platform. 53 patients needed acute hospitalization, in a total of 164 admissions. The most frequent causes for admission were: infectious diseases [27%; 70% due to pneumoniae, of which 74% had SSc-associated interstitial lung disease (ILD)], cardiac disease (16.5%), peripheral vascular disease [12.8%; all due to digital ulcers], pulmonary hypertension (PH) (9.8%) and ILD (9.1%). There was an increase in admissions due to cardiac disease over the 10 years of follow-up, and a decrease of ILD over the last 5 years. Fourteen patients died (in-hospital mortality of 9%) mainly due to pneumoniae (36%), heart failure (21%), neoplastic diseases (21%), PH (14%) and ILD (7%). From all the admissions due to infection 70.5% were under immunosuppression at the time of the hospitalization. The frequency of acute admissions superior to 1 was associated with infection (OR 2.29, 95%CI 1.11-4.71). There were several factors associated with both acute admissions and mortality, including: gender, race, digital ulcers, cardiac dysfunction, ILD and PH. Infection was the principal cause of acute hospitalization and mortality, mainly due to pneumoniae. Although a high percentage of those had ILD, it has been decreasing in the last years in our cohort, as a direct cause of hospital admission and mortality, possibly reflecting the advances in its management.
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Affiliation(s)
- Joana Caetano
- Systemic Autoimmune Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, IC-19 Venteira, 2720-276 Amadora, Portugal
- CEDOC/NOVA Medical School, R. Câmara Pestana 6, 1150-078 Lisbon, Portugal
| | - Frederico Batista
- Systemic Autoimmune Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, IC-19 Venteira, 2720-276 Amadora, Portugal
- CEDOC/NOVA Medical School, R. Câmara Pestana 6, 1150-078 Lisbon, Portugal
| | - Marta C. Amaral
- Systemic Autoimmune Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, IC-19 Venteira, 2720-276 Amadora, Portugal
- CEDOC/NOVA Medical School, R. Câmara Pestana 6, 1150-078 Lisbon, Portugal
| | - Susana Oliveira
- Systemic Autoimmune Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, IC-19 Venteira, 2720-276 Amadora, Portugal
| | - José D. Alves
- Systemic Autoimmune Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, IC-19 Venteira, 2720-276 Amadora, Portugal
- CEDOC/NOVA Medical School, R. Câmara Pestana 6, 1150-078 Lisbon, Portugal
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Carr ZJ, Klick J, McDowell BJ, Charchaflieh JG, Karamchandani K. An Update on Systemic Sclerosis and its Perioperative Management. CURRENT ANESTHESIOLOGY REPORTS 2020; 10:512-521. [PMID: 32904358 PMCID: PMC7455511 DOI: 10.1007/s40140-020-00411-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of Review Systemic sclerosis or scleroderma (SSc) is a systemic, immune-mediated disease characterized by abnormal cutaneous and organ-based fibrosis that results in progressive end-organ dysfunction and decreased survival. SSc results in significant challenges for the practicing anesthesiologist due to its rarity, multi-system involvement, and limited evidence-based guidance for optimal perioperative care. In this update, we briefly discuss the recent evidence on the pathophysiology and current management of SSc, review the anesthesia-related literature, and extrapolate these observations into an optimal perioperative strategy for the care of SSc patients. Recent Findings Evidence shows that patients with SSc demonstrate an increased risk for perioperative myocardial infarction, high rates of interstitial lung disease, pulmonary arterial hypertension, neurological disease, gastric dysmotility disorders, and challenging airway management, all findings that may result in suboptimal perioperative outcomes. Summary Advances in SSc medical management have resulted in improved survival, likely increasing the number of patients who will be exposed to perioperative care. Optimal perioperative management and risk stratification should expand beyond the well-described airway challenges and consider numerous systemic manifestations of systemic sclerosis such as pulmonary arterial hypertension, interstitial lung disease, and cardiac sequelae.
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Affiliation(s)
- Zyad J. Carr
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510 USA
- Yale University School of Medicine, New Haven, CT 06510 USA
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT 05405 USA
- Larner College of Medicine at The University of Vermont, Burlington, VT 05405 USA
| | - Brittany J. McDowell
- Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033 USA
- Penn State School of Medicine, Hershey, PA 17033 USA
| | - Jean G. Charchaflieh
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510 USA
- Yale University School of Medicine, New Haven, CT 06510 USA
| | - Kunal Karamchandani
- Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033 USA
- Penn State School of Medicine, Hershey, PA 17033 USA
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Akuka A, Watad A, Comaneshter D, Cohen AD, Amital H, Bragazzi NL. Systemic sclerosis patients are at higher risk of hyperthyroidism and have a worse survival than those without hyperthyroidism: A nationwide population-based cohort study. Eur J Clin Invest 2019; 49:e13177. [PMID: 31633804 DOI: 10.1111/eci.13177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/18/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND A high prevalence of thyroid disorders has been reported in patients with autoimmune diseases. The link between hyperthyroidism and systemic sclerosis (SSc) has been relatively overlooked, and only a few studies utilizing small samples or case reports have been reported so far. OBJECTIVES To investigate the association between SSc and hyperthyroidism. METHODS We designed a case-control study utilizing the medical database of the Clalit Health Services. Chi-square and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. RESULTS The study included 2,431 SSc patients and 12,710 age- and sex-matched controls. The mean age of the study population was 63.32 ± 18.06 years (median 66 years), and female-to-male ratio was 4.5:1. Age (P < .0001, OR 1.03 [95% CI 1.02-1.04]), female sex (P = .0015, OR 1.86 [95% CI 1.27- 2.74]) and diagnosis of SSc (P = .0011, OR 1.81[95% CI 1.27-2.58]) were all independently associated with hyperthyroidism. Patients with SSc and hyperthyroidism had 1.54-fold increase of mortality rates during a mean follow-up of 17 years than SSc patients without hyperthyroidism, even though at the Cox multivariate survival analysis, only age (HR 1.06 [95% CI 1.06-1.07], P < .0001) and diagnosis of SSc (HR 2.35 [CI 2.06 to 2.69], P < .0001) resulted associated with a higher risk of mortality. CONCLUSIONS Hyperthyroidism is highly prevalent among SSc patients and can negatively impact on their survival rates. Therefore, a pre-emptive screening may be warranted in all SSc patients. Further studies are needed to evaluate whether tight control and optimal treatment for hyperthyroidism may lead to a reduction of all-cause mortality in patients with SSc.
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Affiliation(s)
- Aviram Akuka
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Doron Comaneshter
- Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicola L Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.,Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Abstract
Systemic sclerosis (SSc) is a rare disease characterized by widespread collagen deposition resulting in fibrosis. Although skin involvement is the most common manifestation and also the one that determines the classification of disease, mortality in SSc is usually a result of respiratory compromise in the form of interstitial lung disease (ILD) or pulmonary hypertension (PH). Clinically significant ILD is seen in up to 40% of patients and PH in up to 20%. Treatment with either cyclophosphamide or mycophenolate has been shown to delay disease progression, whereas rituximab and lung transplantation are reserved for refractory cases.
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9
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Ram Poudel D, George M, Dhital R, Karmacharya P, Sandorfi N, Derk CT. Mortality, length of stay and cost of hospitalization among patients with systemic sclerosis: results from the National Inpatient Sample. Rheumatology (Oxford) 2018; 57:1611-1622. [DOI: 10.1093/rheumatology/key150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Indexed: 01/23/2023] Open
Affiliation(s)
| | - Michael George
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Reading Hospital, Reading, USA
| | - Paras Karmacharya
- Department of Medicine, Reading Hospital, Reading, USA
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Nora Sandorfi
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris T Derk
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
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10
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Amoda O, Ravat V, Datta S, Saroha B, Patel RS. Trends in Demographics, Hospitalization Outcomes, Comorbidities, and Mortality Risk among Systemic Sclerosis Patients. Cureus 2018; 10:e2628. [PMID: 30027020 PMCID: PMC6044481 DOI: 10.7759/cureus.2628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective This study determines trends in demographics and hospitalization outcomes among patients admitted for systemic sclerosis (SScl) and evaluates the differences between comorbidities. Methods The study used data from the Nationwide Inpatient Sample (NIS) for the years 2010–2014. We identified SScl as the primary diagnosis and the associated medical and psychiatric comorbidities using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) codes. The differences in comorbidities and in-hospital mortality were quantified using multinomial logistic regression (odds ratio (OR)). Results Inpatient admissions for SScl decreased over the period 2010-2014 by 15.9% (p < 0.001). There was an increasing trend in the 61-80 years age group as they had a 29% increase in admissions and a higher risk of in-hospital mortality (OR = 2.113; p = 0.020). The differences between races showed weaker linear trends, with Caucasians (57.5%) showing an increasing trend, and African Americans (24.3%) and Hispanics (11.8%) having a decreasing trend (p < 0.001). However, Hispanics had the highest risk of mortality (OR = 1.295; p = 0.001) during hospitalization. In-hospital mortality had a linear decreasing trend, with a 10.3% decrease in deaths in 2010, and a 9.1% decrease in 2014 (p < 0.001). Hypertension (47.3%), pulmonary circulation disorders (40.1%), pulmonary fibrosis (29.7%), and congestive heart failure (24.4%) constituted the majority of comorbidities. Comorbid diabetes increased the risk of in-hospital mortality in SScl patients by four times (OR = 3.914; p = 0.003). Esophageal reflux disorder was present in only 6.7% of SScl patients, but it increased the risk of in-hospital mortality (OR = 2.643: p < 0.001). Among psychiatric comorbidities, depression (OR = 1.526; p = 0.001) and psychosis (OR = 1.743; p = 0.039) both increased the risk of in-hospital mortality. Conclusion We observed the various comorbidities that were associated with substantial and significant differences in the risk of in-hospital mortality. We assert that these findings indicate that comorbid conditions are influential factors that must be considered in models of health-related quality of life (HRQOL) in SScl. More attention needs to be paid to the elderly population at risk of having a higher risk of inpatient death. Further research to guide the development of clinical care models for targeting early diagnosis and treatment of comorbidities in SScl is necessary to reduce both mortality and morbidity, as well as improve the quality of care for these patients.
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Affiliation(s)
- Oluyemisi Amoda
- College of Public Health, University of South Florida, Tampa, USA
| | - Virendrasinh Ravat
- Department of Infectious Disease, Clinical Infectious Disease Specialist, Las vegas, USA
| | - Sorabh Datta
- Department of Internal Medicine, Providence Hospital, Washington, D.C., USA
| | - Bipin Saroha
- Department of Internal Medicine, University of Illinois, Chicago College of Medicine, Chicago, USA
| | - Rikinkumar S Patel
- Department of Global Public Health, Arcadia University, Philadelphia, USA
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11
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Determinants of mortality in systemic sclerosis: a focused review. Rheumatol Int 2017; 38:1847-1858. [PMID: 29116439 DOI: 10.1007/s00296-017-3826-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
Scleroderma (systemic sclerosis) is an autoimmune rheumatic disorder that is characterized by fibrosis, vascular dysfunction, and autoantibody production that involves most visceral organs. It is characterized by a high morbidity and mortality rate, mainly due to disease-related complications. Epidemiological data describing mortality and survival in this population have been based on both population and observational studies. Multiple clinical and non-clinical factors have been found to predict higher likelihood of death among thepatients. Here, we do an extensive review of the available literature, utilizing the PubMed database, to describe scleroderma and non-scleroderma related determinants of mortality in this population. We found that even though the mortality among the general population has declined, scleroderma continues to carry a very high morbidity and mortality rate, however we have made some slow progress in improving the mortality among scleroderma patients over the last few decades.
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Assessment of hospitalization and mortality of scleroderma in-patients: a thirteen-year study. Reumatologia 2017; 55:163-168. [PMID: 29056770 PMCID: PMC5647531 DOI: 10.5114/reum.2017.69776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an uncommon non-hereditary sporadic disease that increases the risk of premature death, especially in diffuse type. We determined the prevalence of SSc in the last 13 years in our rheumatologic hospitals as a referral center for southern Iranian patients, the causes of hospitalization, the average length of stay (LOS), the mortality rate, and the reason for their mortality. MATERIAL AND METHODS A cross-sectional study was performed in Shiraz University of Medical Sciences, Iran. The studied population included all patients diagnosed with systemic sclerosis. We calculated the hospitalization rates, in-hospital mortality rates, and mean LOS. RESULTS There were 446 admissions by 181 patients with SSc. The female to male ratio was about 10.7 : 1. The overall mean LOS was 5.95 days. Digital ulcer and interstitial lung disease (ILD) were the most common causes of hospitalizations among the SSc-related events. For those with a non-SSc-related condition, infection was the most prevalent event. Most of the deaths were due to ILD and pulmonary artery hypertension(PAH), and the overall in-hospital mortality rate was 16.5%. CONCLUSIONS Women with SSc had higher rates of hospitalization but lower in-hospital mortality than men.There were some differences between our study and other similar studies in the causes of hospitalization and in-hospital death among SSc patients, especially the lower age of death. The patients with digital ulcers and those with intestinal lung disease or pulmonary hipertension were most commonly admitted to the hospital in our study group. Probably, increasing the skin care of these patients and asking other specialty groups to cooperate will decrease the high rate of hospitalizations in our population.
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Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections. Int J Mol Sci 2017; 18:ijms18020293. [PMID: 28146077 PMCID: PMC5343829 DOI: 10.3390/ijms18020293] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.
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