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Martínez-Díaz G, Cruz-Domínguez MP, López Zamora B, Ramirez-Facio J, Medina G, Munguía-Cruz RX, Saavedra-Salinas MA, Arrucha-Cozaya M, Vera-Lastra OL, Peralta-Amaro AL, Florez-Durante ÓI, Gil-Galindo KA. Influence of visceral adiposity on cardiovascular risk in patients with systemic sclerosis. Rheumatol Int 2024; 44:621-630. [PMID: 37684492 DOI: 10.1007/s00296-023-05421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by systemic inflammation, endothelial dysfunction, generalized fibrosis and high cardiovascular mortality. The evaluation of cardiovascular risk through the visceral adiposity index (VAI) has been helpful due to its direct relationship to the body and visceral fat percentage. We evaluated the influence of body composition and anthropometrics on cardiovascular risk as measured by VAI in healthy controls (HC) and SSc. An analytical cross-sectional study of 66 participants (33 SSc and 33 HC), mean age 52.7 ± 10, 95% women, was conducted from August 2020 to January 2021. Inclusion criteria in cases were consecutive patients with SSc (ACR/EULAR 2013), 63.6% were diffuse cutaneous (dcSS) subtype, and 36.4 were limited cutaneous (lcSS) subtype. HC was matched by age and gender. Serum lipid profiles and InBody anthropometrics were analyzed and compared. We performed descriptive statistics, bivariate analysis with Student's t, or Mann-Whitney U, correlation and chi-square according to the variable type and distribution. Total cholesterol was significantly higher in SSc than HC (345 vs 194, p = < 0.001). The BMI was higher in HC (26.2 vs 28.9, p < 0.001). Kilograms of muscle (19.8 vs 28.9, p < 0.001) and total fat (23.4 vs 28.9, p < 0.001) were lower in SSc patients compared to HC. VAI was similar when BMI < 25, but significantly higher when BMI > 25 in SSc than in HC (3 vs 1.9, p = 0.030). The increase in BMI at overweight or obese in SSc is associated with a significant increase in cardiovascular risk.
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Affiliation(s)
- Gabriela Martínez-Díaz
- Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Campus Puebla, Puebla, Puebla, Mexico
| | - María Pilar Cruz-Domínguez
- Direction of Education and Research, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico.
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Berenice López Zamora
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
- Postgraduate studies section and research, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Jordan Ramirez-Facio
- Internal Medicine Resident, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Gabriela Medina
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS; Universidad Nacional Autónoma de México, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Miguel Angel Saavedra-Salinas
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Michelle Arrucha-Cozaya
- Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Campus Puebla, Puebla, Puebla, Mexico
| | - Olga Lidia Vera-Lastra
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Ana Lilia Peralta-Amaro
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Óscar Iván Florez-Durante
- Laboratory Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Kybaná Aurora Gil-Galindo
- Postgraduate studies section and research, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
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Arrucha-Cozaya M, Zamora-Zúñiga NC, Miranda-Hernández D, Bustamante-González R, Martínez-Díaz G, Tovar-Rodríguez D, López-Zamora B, Del Pilar Cruz-Domínguez M, Gracia-Ramos AE, Saavedra MA. In-hospital mortality and associated factors in patients with systemic lupus erythematosus: analysis over more than 11 years in a reference hospital center. Rheumatol Int 2023; 43:2221-2231. [PMID: 37776497 DOI: 10.1007/s00296-023-05469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
Systemic lupus erythematosus (SLE) is a disease that affects the immune system, and it can lead to increased morbidity and mortality. The primary causes of mortality for individuals with SLE are disease activity, infections, drug toxicity, and other health conditions. The aim of this study is to estimate the mortality rate of patients with SLE who are hospitalized, describe the causes of death, and identify factors associated with mortality. The study was conducted at a referral hospital from 2009 to 2021, utilizing a nested case-control design. The records of patients with SLE who were hospitalized in the Department of Rheumatology were reviewed. Cases were identified as individuals who died during their hospitalization, while controls were those who were discharged alive during the same period. Elective hospitalizations were not included in the study. The primary causes of death were recorded, and demographic, clinical, laboratory, and immunological variables were analyzed as potential risk factors associated with in-hospital mortality. The study included 105 patients who died while hospitalized and 336 who were discharged alive. The estimated mortality rate was 10.93 deaths per 1000 hospital admissions per year. The leading causes of death were SLE activity (20%), infections (34.2%), or a combination of both (24.8%). Risk factors associated with in-hospital mortality were any infection (OR 2.5, CI 95% 1.2-5.2), nosocomial infections (OR 5.0, CI 95% 1.8-13.7), SLEDAI-2K > 2 (OR 2.0, CI 95% 1.02-3.8), lymphopenia (OR 2.1, CI 95% 1.01-4.6), anemia (OR 2.9, CI 95% 1.4-5.7), and thrombocytopenia (OR 3.3, CI 95% 1.7-6.4). Disease activity and infections, particularly nosocomial infections, are significant causes of mortality in hospitalized patients with SLE. Furthermore, hematological manifestations play a significant role in in-hospital mortality for these patients.
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Affiliation(s)
| | - Nuria Cecilia Zamora-Zúñiga
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Dafhne Miranda-Hernández
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Reyna Bustamante-González
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | - Berenice López-Zamora
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - María Del Pilar Cruz-Domínguez
- Dirección de Educación e Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Mexico City, Mexico
| | - Abraham Edgar Gracia-Ramos
- Departamento de Medicina Interna, Hospital General Dr. Gaudencio Gonzalez Garza, Centro Médico Nacional La Raza, Mexico City, Mexico
| | - Miguel Angel Saavedra
- División de Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Seris y Zaachila s/n, Col. La Raza, Alc. Azcapotzalco, CP 02990, Mexico City, Mexico.
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