1
|
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.
Collapse
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
| |
Collapse
|
2
|
Coi A, Barsotti S, Santoro M, Almerigogna F, Bargagli E, Caproni M, Emmi G, Frediani B, Guiducci S, Matucci Cerinic M, Mosca M, Parronchi P, Prediletto R, Selvi E, Simonini G, Tavoni AG, Bianchi F, Pierini A. Epidemiology of systemic sclerosis: a multi-database population-based study in Tuscany (Italy). Orphanet J Rare Dis 2021; 16:90. [PMID: 33596949 PMCID: PMC7890847 DOI: 10.1186/s13023-021-01733-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background Systemic Sclerosis (SSc) is a chronic autoimmune disease with a complex pathogenesis that includes vascular injury, abnormal immune activation, and tissue fibrosis. We provided a complete epidemiological characterization of SSc in the Tuscany region (Italy), considering prevalence and incidence, survival, comorbidities and drug prescriptions, by using a multi-database population-based approach. Cases of SSc diagnosed between 1st January 2003 and 31st December 2017 among residents in Tuscany were collected from the population-based Rare Diseases Registry of Tuscany. All cases were linked to regional health and demographic databases to obtain information about vital statistics, principal causes of hospitalization, complications and comorbidities, and drug prescriptions. Results The prevalence of SSc in Tuscany population resulted to be 22.2 per 100,000, with the highest prevalence observed for the cases aged ≥ 65 years (33.2 per 100,000, CI 95% 29.6–37.3). In females, SSc was predominant (86.7% on the total) with an overall sex ratio F/M of 6.5. Nevertheless, males presented a more severe disease, with a lower survival and significant differences in respiratory complications and metabolic comorbidities. Complications and comorbidities such as pulmonary involvement (HR = 1.66, CI 95% 1.17–2.35), congestive heart failure (HR = 2.76, CI 95% 1.80–4.25), subarachnoid and intracerebral haemorrhage (HR = 2.33, CI 95% 1.21–4.48) and malignant neoplasms (HR = 1.63, CI 95% 1.06–2.52), were significantly associated to a lower survival, also after adjustment for age, sex and other SSc-related complications. Disease-modifying antirheumatic drugs, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors were the drugs with the more increasing prevalence of use in the 2008–2017 period. Conclusions The multi-database approach is important in the investigation of rare diseases where it is often difficult to provide accurate epidemiological indicators. A population-based registry can be exploited in synergy with health databases, to provide evidence related to disease outcomes and therapies and to assess the burden of disease, relying on a large cohort of cases. Building an integrated archive of data from multiple databases linking a cohort of patients to their comorbidities, clinical outcomes and survival, is important both in terms of treatment and prevention.
Collapse
Affiliation(s)
- Alessio Coi
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy.
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Santoro
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy
| | - Fabio Almerigogna
- Immunoallergology Unit, , Careggi University Hospital, Florence, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Marzia Caproni
- Rare Dermatological Diseases Unit, USL Toscana Centro, Firenze, Italy.,ERN-SKIN Diseases Centre, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, "Le Scotte" Hospital, Siena, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Renato Prediletto
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy.,Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Enrico Selvi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Gabriele Simonini
- Rheumatology Unit, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Antonio Gaetano Tavoni
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Fabrizio Bianchi
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy.,Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy.,Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
| |
Collapse
|
3
|
Singh JA, Cleveland JD. Serious infections in people with systemic sclerosis: a national US study. Arthritis Res Ther 2020; 22:163. [PMID: 32600412 PMCID: PMC7322895 DOI: 10.1186/s13075-020-02216-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To study incidence, time trends, and outcomes of serious infections in systemic sclerosis (SSc). Methods We used the 1998–2016 US National Inpatient Sample data. We examined the epidemiology, time trends, and outcomes of five serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in hospitalized people with SSc. We performed multivariable-adjusted logistic regression analyses to analyze independent association of factors with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting) and in-hospital mortality. Results There were 49,904,955 hospitalizations with serious infections in people without SSc and 61,615 in those with SSc. During 1998–2016, the most common serious infections in SSc were pneumonia (45%), sepsis (32%), SSTI (19%), UTI (3%), and OI (3%). In 2013–2014, sepsis surpassed pneumonia as the most common serious infection; by 2015–2016, sepsis was 1.8 times more common than pneumonia. Over the study period, hospital charges increased, while length of hospital stay and in-hospital mortality decreased, overall and for each serious infection. Multivariable-adjusted analyses showed that sepsis, age ≥ 80 years, and Deyo-Charlson score ≥ 2 were associated with significantly higher odds of healthcare utilization and in-hospital mortality, and Medicare or Medicaid insurance payer, Northeast location, urban teaching or non-teaching hospital, and medium or large hospital bed size with significantly higher odds of healthcare utilization. Conclusions Outcomes in people with SSc hospitalized with serious infections have improved over time, except higher hospital charges. Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham Veterans Affairs (VA) Medical Center, 700 19th St S, Birmingham, AL, 35233, USA. .,Department of Medicine at School of Medicine, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA.
| | - John D Cleveland
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294-0022, USA
| |
Collapse
|
4
|
Singh JA, Cleveland JD. Systemic sclerosis is associated with knee arthroplasty outcomes: a National US study. Clin Rheumatol 2019; 39:85-92. [PMID: 31444650 DOI: 10.1007/s10067-019-04754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/01/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess whether systemic sclerosis (SSc) is associated with total knee arthroplasty (TKA) outcomes. METHODS We used the 1998-2014 US National Inpatient Sample. We conducted multivariable-adjusted logistic regression analyses to examine the association of a diagnosis of SSc with post-TKA in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, hospital stay, non-home vs. home discharge). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. RESULTS Our cohort included 8,123,388 people without SSc and 3894 people with SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher odds of transfusion, hospital stay > 3 days and non-home discharge with higher OR of 1.42 (95 % CI, 1.20, 1.69), 1.29 (95 % CI, 1.11, 1.49), and 1.29 (95 % CI, 1.11, 1.49), respectively. No differences were seen in revision, 0.68 (95 % CI, 0.10, 4.69) or hospital charges above the median, 1.01 (95 % CI, 0.70, 1.46). Differences in implant infection or mortality were not estimable, since none of the patients with SSc had implant infection or died. Sensitivity analyses that adjusted the main analysis additionally for hospital-level variables confirmed study findings with minimal or no attenuation of OR. CONCLUSION SSc was associated with higher risk of transfusion and increased healthcare utilization after TKA. Future studies should examine if interventions can address modifiable factors to further optimize these outcomes.Key Points• Systemic sclerosis was independently associated with higher healthcare utilization after TKA.• The adjusted odds of transfusion was higher in people with systemic sclerosis compared to those without systemic sclerosis who underwent TKA.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA. .,Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
| | - John D Cleveland
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|