Relationship between change in skin score and disease outcome in diffuse cutaneous systemic sclerosis - Application of a latent linear trajectory model
Relationship between change in skin score and disease outcome in diffuse cutaneous systemic sclerosis - Application of a latent linear trajectory model
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DOI：
10.1002/art.22721
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发表时间：
2007-07-01
影响因子：
--
通讯作者：
Denton, Christopher P.
中科院分区：
文献类型：
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作者：
Shand, Lynne;Lunt, Mark;Denton, Christopher P.
目标。探讨弥漫性皮肤系统性硬化症（dcSSc）患者皮肤疾病严重程度变化与发病率和死亡率的关系。从一个大型单中心队列中，我们确定了225例dcSSc患者，这些患者在SSc首次非雷诺现象表现发病后24个月内可获得一系列临床信息。分析的终点包括死亡和心脏、肺、肾和胃肠道受累。应用潜在线性轨迹模型（LTM）识别在前3年随访中具有相似的改良罗德曼皮肤厚度评分（MRSS）变化轨迹的患者。比较3个不同LTM亚组的临床结果。LTM允许将131例患者（58%）分为具有不同皮肤评分轨迹的3个亚组中的1个。基线皮肤评分高且随访期间改善甚微的患者亚组生存率最低（P = 0.003）。然而，临床终点的频率在最有利的亚组（即低初始MRSS和随后的改善）和高基线MRSS和无改善的亚组相似。有趣的是，终点频率在初始MRSS高且随后改善的亚组中最高，这表明持续严重的皮肤病并不一定能预测内脏并发症的数量，并且皮肤评分与dcSSc内脏脏器受损伤之间的关系比以前认为的要复杂。虽然在皮肤相关结果最差的患者中死亡率最高，但没有观察到疾病负担与皮肤评分变化之间的简单关系。
Objective. To explore the relationship between changes in the severity of skin disease and morbidity and mortality in patients with diffuse cutaneous systemic sclerosis (dcSSc).Methods. From a large single-center cohort, we identified 225 patients with dcSSc for whom serial clinical information was available from within 24 months of the onset of the first non-Raynaud's phenomenon manifestation of SSc. The end points analyzed included death and heart, lung, kidney, and gastrointestinal tract involvement. Latent linear trajectory modeling (LTM) was applied to identify patients with a similar trajectory of modified Rodnan skin thickness score (MRSS) changes over the first 3 years of followup. Clinical outcomes were compared between 3 different LTM subgroups.Results. LTM permitted classification of 131 patients (58%) into 1 of 3 subgroups with different skin score trajectories. Survival was lowest in the subgroup of patients who had a high baseline skin score and experienced little improvement during followup (P = 0.003). However, the frequency of clinical end points was similar in the subgroup with the most favorable trajectory (i.e., a low initial MRSS and subsequent improvement) and the subgroup with a high baseline MRSS and no improvement. Interestingly, the end point frequency was greatest in the subgroup with a high initial MRSS and subsequent improvement, suggesting that sustained severe skin disease does not necessarily predict the number of visceral complications, and that the relationship between the skin score and internal organ involvement in dcSSc is more complex than previously thought.Conclusion. Although mortality was highest among patients with the worst skin-related outcomes, no simple relationship between burden of disease and change in skin score was observed.