Acute hospitalization in a cohort of patients with systemic sclerosis: a 10-year retrospective cohort study.
Acute hospitalization in a cohort of patients with systemic sclerosis: a 10-year retrospective cohort study.
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DOI：
10.1007/s00296-021-04983-4
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发表时间：
2022-08
影响因子：
4
通讯作者：
Alves JD
中科院分区：
文献类型：
--
作者：
Caetano J;Batista F;Amaral MC;Oliveira S;Alves JD
本研究旨在分析 SSc 队列中急性住院和死亡的原因和预测因素。对 2010 年至 2020 年间所有符合 2013 年 EULAR/ACR 分类标准的 SSc 患者急性入院情况进行回顾性分析，来自 95 名患者的单中心队列。在此期间，我们医院登记的 SSc 患者总数为 123 例。临床数据来自我们机构的医疗档案和国家医疗保健登记平台。共有 164 名患者入院，其中 53 名患者需要紧急住院治疗。最常见的入院原因是：传染病[27%； 70% 因肺炎，其中 74% 患有 SSc 相关间质性肺疾病 (ILD)]、心脏病 (16.5%)、周围血管疾病 [12.8%；都是由于指溃疡]、肺动脉高压 (PH) (9.8%) 和 ILD (9.1%)。在 10 年的随访中，因心脏病入院的人数有所增加，而在过去 5 年中，因 ILD 入院的人数有所减少。 14 名患者死亡（院内死亡率为 9%），主要死于肺炎（36%）、心力衰竭（21%）、肿瘤性疾病（21%）、肺动脉高压（14%）和间质性肺病（7%）。在所有因感染入院的患者中，70.5% 在住院时处于免疫抑制状态。急性入院频率超过 1 次与感染相关（OR 2.29，95% CI 1.11–4.71）。有几个因素与急性入院和死亡率相关，包括：性别、种族、指溃疡、心功能不全、ILD 和 PH。感染是急性住院和死亡的主要原因，主要是肺炎。尽管其中患有 ILD 的比例很高，但在我们的队列中，作为入院和死亡的直接原因，ILD 在过去几年中一直在下降，这可能反映了其管理的进步。
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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