Systemic Sclerosis Inpatient Mortality has not improved from 1995-2011. Results from a National Irish audit of Scleroderma Co-morbidities
L. Harty, D. Fitzgerald, M. Henry, J. Ryan, S. Harney
Rheumatology and Respiratory Departments, Cork University Hospital
Despite the advent of potent therapies it is not clear that longevity of patients with systemic sclerosis (SSc) has improved.
To evaluate age of death of SSc inpts, LOS and comorbidities in SSc patients.
The HIpE system was evaluated from 57 hospitals from 1995-2011 for SSc inpts. Results are shown as totals and mean (SD). Mann-whitney u and logistic regression were employed.
2667 inpt admissions occurred; 4:1, F:M, mean age 59yrs (15). Average 157 (15) admissions occurred annually for SSc patients (r2=0.01,p=0.7). 146 inpts died 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 to 14 days (r2=0.3, p=0.03), as did age of admission (r2=0.4, p<0.01). Autoimmunity 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 CCF, 32 arrhythmia), GI n=301, Rehab n= 151, MSK n=120, Haematological n=89, Renal n= 85. 16 pregnancies occurred with 2 miscarriages, 3 pre-eclampsia, and 9 unspecified complications. Imaging was the commonest procedure (n=346), followed by IV therapy (n=297), rehabilitation (n=277), OGD (n=208) with 62 limb amputations and 9 kidney transplants.
Age of death among SSc inpts is not improving, worse in men. SSc LOS is increasing. Cardiopulmonary comorbidity predominates among Irish SSc inpts requiring more awareness and therapeutics for this aspect of SSc.