Forman Crystal J, Olson Stephen W, Gordon Sarah M, Hughes James B, Stitt Rodger S, Bailey Wayne T, Edison Jess D, Nee Robert
Brooke Army Medical Center, Fort Sam Houston, Texas.
Walter Reed National Military Medical Center and Uniformed Services University, Bethesda, Maryland.
Arthritis Care Res (Hoboken). 2023 Apr;75(4):801-807. doi: 10.1002/acr.24807. Epub 2022 Dec 20.
Scleroderma renal crisis (SRC) is a rare and severe manifestation of systemic sclerosis (SSc). Although it is well documented that Black patients with SSc have worse morbidity and mortality than non-Black patients, racial predilection for SRC is underreported. We examine the association of race and future development of SRC in an SSc cohort.
Using the electronic health record of the US Military Health System, we conducted a comprehensive chart review of each patient with SSc from 2005 to 2016. The final study cohort was comprised of 31 SRC cases and 322 SSc without SRC controls. We conducted logistic regression of SRC as the outcome variable and race (Black versus non-Black) as the primary predictor variable, adjusted for age, estimated glomerular filtration rate, hypertension, and proteinuria at SSc diagnosis.
Of 353 patients, 294 had identifiable race (79 Black, 215 non-Black). Thirteen of 79 Black patients (16.5%) versus 16 of 215 (7.4%) non-Black patients developed SRC (P = 0.02). On adjusted analysis, Black patients had a significantly higher risk of developing SRC than non-Black patients (odds ratio 6.4 [95% confidence interval 1.3-31.2], P = 0.02). Anti-Ro antibody was present in a higher proportion of Black SRC patients versus Black patients without SRC (45% versus 14%, P = 0.01). Conversely, older age, thrombocytopenia, and anti-RNA polymerase III antibody at SSc diagnosis were significantly associated with future SRC in the non-Black cohort.
Black race was independently associated with a higher risk of future SRC. Further studies are needed to elucidate the mechanisms that underlie this important association.
硬皮病肾危象（SRC）是系统性硬化症（SSc）的一种罕见且严重的表现形式。尽管有充分记录表明，患有SSc的黑人患者的发病率和死亡率高于非黑人患者，但SRC的种族倾向报道较少。我们研究了SSc队列中种族与SRC未来发生情况的关联。
利用美国军事卫生系统的电子健康记录，我们对2005年至2016年期间的每位SSc患者进行了全面的病历审查。最终的研究队列包括31例SRC病例和322例无SRC的SSc对照。我们以SRC作为结局变量，以种族（黑人与非黑人）作为主要预测变量进行逻辑回归分析，并对SSc诊断时的年龄、估计肾小球滤过率、高血压和蛋白尿进行了校正。
在353例患者中，294例患者的种族可识别（79例黑人，215例非黑人）。79例黑人患者中有13例（16.5%）发生了SRC，而215例非黑人患者中有16例（7.4%）发生了SRC（P = 0.02）。经校正分析，黑人患者发生SRC的风险显著高于非黑人患者（优势比6.4 [95%置信区间1.3 - 31.2]，P = 0.02）。与无SRC的黑人患者相比，发生SRC的黑人患者中抗Ro抗体的比例更高（45%对14%，P = 0.01）。相反，在非黑人队列中，年龄较大、血小板减少以及SSc诊断时的抗RNA聚合酶III抗体与未来发生SRC显著相关。
黑人种族与未来发生SRC的较高风险独立相关。需要进一步研究以阐明这一重要关联背后的机制。
