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Abstract Number: 732

Predictors of Inpatient Mortality in Patients with Systemic Sclerosis: A Case Control Study

Shiv Tej Sehra1, Chris T. Derk1, Andrew Kelly2 and Joshua Baker3, 1Medicine/Rheumatology, University of Pennsylvania, Philadelphia, PA, 2Medicine, Pennsylvania Hospital, Philadelphia, PA, 3Medicine/Rheumatology, University of Pennsylvania and Philadelphia VAMC, Philadelphia, PA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: death, Lung Disease, Morbidity and mortality and systemic sclerosis

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Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics: Systemic Sclerosis Measures and Outcomes

Session Type: Abstract Submissions (ACR)

Background/Purpose

There are few published studies on predictors of inpatient mortality in patients with systemic sclerosis (SSc). Knowledge of these predictors is important for early identification of patients at high-risk of inpatient death and recognition of potential modifiable factors. Currently available data are mostly from large databases which lack a granular view.  The aim of this study was to define factors associated with inpatient mortality in SSc.

Methods

All admissions coded for SSc (ICD-9 710.1) at the Hospital of University of Pennsylvania, between Jan 1, 2001 and Dec 31, 2011 were reviewed. The diagnosis of SSc was confirmed, and deaths were identified by chart review. For each death, an age (±5 years), sex and gender matched control with SSc (who did not die during their hospitalization) was identified. We hypothesized group differences in SSc characteristics, non–SSc co-morbidities and admission labs (as summarized in Table 1). Group differences were analyzed using Student’s t-test (and non parametric equivalents) as well as Chi2tests for dichotomous variables. Exposures associated with death in univariate analyses were used to form a final parsimonious multivariable logistic regression model.

Results

A total of 593 admissions and 30 deaths were identified. Data was not available on 1 death. A significant difference in non–SSc lung disease (p = 0.031), aspiration events (p < 0.001), WBC count (p = 0.048), Blood Urea Nitrogen (BUN) (p <0.001) and hemoglobin (Hb) (p = 0.025) was noted between subjects that died compared to matched controls. Odds of death were higher in patients with a higher BUN (OR = 1.06, CI = 1.02–1.11), non–SSc lung disease (OR = 3.87, CI = 1.26–11.88) and aspiration events (OR = 30, CI = 3.58–250.80), and lower in patients with a higher Hb (OR = 0.73, CI = 0.54–0.97). High BUN, a history of aspiration events and low Hb were found to be independently associated with mortality.

Conclusion

A high BUN on admission, low Hb, non–SSc Lung disease, and aspiration events are associated with higher in–hospital mortality in patients with SSc. The odds of dying in the hospital were 30 times in patients who aspirated. Therefore, stringent measures should be taken to prevent aspiration in these patients. Also, further study is needed to identify factors that predispose to acute aspiration events.

Table 1

Parameter

Death

Control

p – value

Transfer

6 of 29

8 of 19

0.76

Raynaud’s Phenomenon

22 of 23

22 of 23

1

Digital Ulcers

2 of 22

2 of 22

1

SSc – ILD

12 of 28

8 of 28

0.403

Pulmonary Artery HTN

16 of 22

14 of 22

0.747

SSc Reflux

22 of 25

22 of 25

1

Bacterial Overgrowth

2 of 19

3 of 19

1

SSc Renal Crisis

3 of 25

0 of 25

0.235

SSc – MSK

2 of 23

4 of 23

0.665

SSc – Cardiac

4 of 25

3 of 25

1

Coronary Artery Disease

19 of 27

13 of 27

0.176

Arrhythmia

13 of 27

9 of 27

0.277

Hypertension

23 of 29

18 of 29

0.370

Coronary Artery Disease

12 of 22

9 of 22

0.547

Chronic Renal Failure

9 of 29

4 of 29

0.207

Liver Disease

4 of 29

1 of 29

0.352

Diabetes Mellitus

7 of 29

2 of 29

0.144

Non SSc Lung Disease

16 of 29

7 of 29

0.031

Any Cause Lung Disease

18 of 29

14 of 29

0.429

Aspiration Events

15 of 29

1 of 29

< 0.001

 

 

 

 

Parameter

Mean (SD)

Mean (SD)

p – value

Hemoglobin

10.46 (1.72)

11.71 (2.31)

0.025

Hematocrit

31.89 (4.93)

35.43 (6.23)

0.022

WBC

12.98 (11.1)

8.5 (3.67)

0.048

BUN

37.23 (21.84)

19.77 (10.92)

<0.001

Creatinine

1.39 (0.71)

1.07 (0.78)

0.133

Sodium

137.86 (4.98)

138.25 (3.79)

0.741

Potassium

4.11 (0.69)

4.16 (0.66)

0.788

Platelets

256.36 (125.71)

228.75 (70.34)

0.315

Table 2

Univariate Logistic Regression

Parameter

Odds Ratio (95% CI)

p – value

Hemoglobin

0.73 (0.54 – 0.97)

0.032

BUN

1.06 (1.02 – 1.11)

0.004

Aspiration

30 (3.58 – 250.80)

0.002

Other Pulmonary

3.87 (1.26 – 11.88)

0.018

WBC

1.11 (0.99 – 1.25)

0.066

 

Multivariate Logistic Regression

Parameter

Odds Ratio (95% CI)

p – value

BUN

1.09 (1.02 – 1.17)

0.007

Hemoglobin

0.63 (0.43 – 0.93)

0.021

Aspiration

41.05 (3.62 – 464.91)

0.003



Disclosure:

S. T. Sehra,
None;

C. T. Derk,
None;

A. Kelly,
None;

J. Baker,
None.

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