Background/Purpose: Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis. It presents with sudden onset of severe hypertension, a rise in serum creatinine levels with oliguria, and/or thrombotic microangiopathy. We aimed to identify the differences in outcomes and comorbidities in patients with this SRC in comparison to patients presenting with hypertensive emergency without SRC (HE).

Methods: The 2016-2020 National Inpatient Sample database (NIS) was analyzed to identify adult hospitalizations with SRC, using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The studied primary outcome was to assess SRC versus HE inpatient mortality and inpatient morbidities. A multivariate logistic regression, and linear regression analyses were used to adjust for possible confounders.

Results: Logistic and linear regression analyses showed that patients with SRC had a higher odds of mortality (adjusted Odds Ratio [aOR] of 1.3, 95% Confidence Interval [CI] 1.24-1.39), ischemic stroke (aOR: 1.44, CI: 1.40-1.49), acute coronary syndrome (aOR: 1.91, CI: 1.87-1.95), cardiac conduction abnormalities (aOR: 1.32, CI: 1.30-1.35), aortic disease (aOR: 1.51, CI: 1.46-1.55), pulmonary arterial hypertension (aOR: 3.13, CI: 2.9-3.39), acute pulmonary edema (aOR: 2.34, CI: 2.26-2.42), acute exacerbation of heart failure (aOR: 1.23, CI: 1.21-1.25), and paroxysmal atrial fibrillation (aOR: 1.02, CI: 1.008-1.046) in comparison to HE. Figure 1 shows the Forrest plot for multivariate analysis of in hospital morbidities when adjusted for patient demographics, comorbidities, and hospital characteristics.

Conclusion: In conclusion, our study underscores the notable distinctions between patients with scleroderma renal crisis and those presenting with hypertensive emergencies without scleroderma. Our findings demonstrate that patients with scleroderma renal crisis face significantly elevated risks of mortality, ischemic stroke, acute coronary syndrome, cardiac conduction abnormalities, aortic disease, pulmonary arterial hypertension, acute pulmonary edema, and acute exacerbation of heart disease. These results highlight the imperative for healthcare providers to exercise heightened caution and tailored management strategies when dealing with scleroderma renal crisis patients due to their heightened susceptibility to complications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/title-patient-characteristics-and-outcomes-of-scleroderma-renal-crisis-versus-hypertensive-emergencies-a-nationwide-comparative-study/