Background/Purpose: Despite the advent of potent immunosuppressive and vasoactive therapies it is not clear that longevity of patients with systemic sclerosis (SSc) has improved. Therefore we sought to evaluate the age of death of SSc inpatients (inpts) relative to general inpts, the number of hospital inpt days and comorbidities in SSc patients.

Methods: The Hospital In-Patient Enquiry system was evaluated from 57 Irish hospitals from 1995-2011 for patients admitted with a diagnosis of SSc. Age, length of stay (LOS), gender and admitting indication were recorded. Results are shown as totals and mean (Standard deviation). Trends were examined by logistic regression analysis; Mann –Whitney  U was used to compare groups. p<0.05 was considered statistically significant. 

Results: 2667 inpt admissions occurred; 4:1, F:M, mean age 59yrs (15). On average 157 (15) admissions occurred annually for SSc patients, without variation (p=0.7). 146 patients died in hospital at average 65yrs (5) without annual improvement (r²=0.03, p=0.5). SSc age of death was younger than general inpts (p<0.0001), whose longevity improved from 72 to 74yrs (r²=0.9, p<0.0001). Male SSc inpts were average 6yrs younger than female at death (60yrs (10) v 66 yrs (6); p<0.01) in contrast to general inpts when men were average 3yrs younger than women at death (70 yrs v 73 yrs). SSc LOS increased from 11 to 14 days (r²=0.3, p=0.03), as did age of admission (r²=0.4, p<0.01). Autoimmune disease (predominantly scleroderma) was the commonest admitting diagnosis (n=945). Lung disease accounted for 383 admissions (170 infection, 62 PAH), CVS disease n=397 (236 limb / cardiac / cerebral ischaemic events, 51 heart failure, 32 arrhythmia), GI n=301, Rehab n= 151, MSK n=120, Haematological n=89 (52 anaemia), Renal n= 85 (51 Failure, 19 infection). 16 pregnancies were recorded with 2 spontaneous abortions, 3 pre-eclampsia incidents, and 9 unspecified complications. Imaging was the commonest principal procedure (n=346), followed by IV therapy (n=297), allied health professional intervention (n=277), gastroscopy (n=208) with 62 patients undergoing limb amputation and 9 having kidney transplants.

Conclusion:   Age of death among SSc inpts is not improving in contrast to unaffected inpts whose age of death is increasing, worse in men. SSc LOS is increasing in contrast to unaffected inpts whose LOS is decreasing. Cardiopulmonary comorbidity predominates among Irish SSc inpts supporting the need for more awareness and therapeutics to address this aspect of SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-sclerosis-inpatient-mortality-has-not-improved-from-1995-2011-results-from-a-national-irish-audit-of-scleroderma-co-morbidities/