Shalamar Medical and Dental College.
John H. Stroger Hospital of Cook County Hospital.
ARP Rheumatol. 2024 Apr-Jun;3(2):95-100.
We aim to study the prevalence and epidemiology of pulmonary arterial hypertension in SS, and the impact of PAH on SSc hospitalizations in the United States population.
We utilized the National Inpatient Sample (NIS) from 2016-2019 to obtain adult hospitalizations with the primary/secondary diagnosis of SSc and coexistent PAH (SSc-PAH). Epidemiological variables, mortality rates, and secondary outcomes were studied including pulmonary embolism, atrial flutter, atrial and ventricular fibrillation, pneumonia, sepsis, cardiac arrest and cardiac & renal failure, and ventilator requirement. Healthcare burden was estimated from total hospital charges (THC) and length of stay (LOS). Statistical analysis was performed on STATA 16.1, using linear and logistic regression analyses.
Out of 126,685 adult systemic sclerosis hospitalizations, 16.89% had PAH (SSc-PAH). The SSc-PAH group had significantly more females (85.4 % vs. 83.8%) and higher mean age (64.85±13.29 vs. 62.56±14.51). More African Americans were in this group than in the control group (19.5% vs. 14.6, p-value<0.001) while Whites (61.3% vs. 65.6%, p<0.001) and Asians (18.0 % vs. 2.8%, p<0.001) were less common. Charlson comorbidity index was higher for the SSc-PAH population (3.42 vs. 2.94, p-value<0.001). SSc-PAH group had a higher adjusted odds ratio (aOR) for mortality (aOR: 1.39, p<0.001), increased LOS (6.64 vs. 6.0 days, p<0.001) increased THC ($83,813 vs. $71,016, p <0.001). For the SSc-PAH group, there were also significantly higher odds of cardiac failure (aOR 3.13), ventilator requirement (aOR 2.15), cardiac arrest (aOR 1.39), kidney failure (aOR 1.63), pulmonary embolism (aOR 1.84), atrial flutter (aOR 1.86) atrial fibrillation (aOR1.56) and pneumonia (aOR 1.22). No significant difference in ventricular fibrillation, sepsis, or respiratory failure was noted.
Pulmonary arterial hypertension in SSc is associated with worse outcomes in terms of mortality and morbidity, and higher healthcare burden compared to SSc without PAH. Also, PAH disproportionately affects White, African American & Asian populations. There remains a pressing need to continue efforts for early diagnosis and management of PAH in SSc patients.
我们旨在研究硬皮病患者肺动脉高压的流行情况和流行病学，并研究肺动脉高压对美国硬皮病患者住院的影响。
我们利用 2016 年至 2019 年的国家住院患者样本（NIS），获得原发性/继发性硬皮病和并存肺动脉高压（SSc-PAH）的成人住院患者的主要/次要诊断。研究了流行病学变量、死亡率和次要结果，包括肺栓塞、心房扑动、心房和心室颤动、肺炎、败血症、心脏骤停和心肾功能衰竭以及呼吸机需求。通过总住院费用（THC）和住院时间（LOS）来估计医疗保健负担。使用 STATA 16.1 进行统计分析，采用线性和逻辑回归分析。
在 126685 例成人系统性硬化症住院患者中，16.89%有肺动脉高压（SSc-PAH）。SSc-PAH 组的女性明显较多（85.4%比 83.8%），平均年龄也较高（64.85±13.29 比 62.56±14.51）。该组的非裔美国人比例高于对照组（19.5%比 14.6%，p 值<0.001），而白人（61.3%比 65.6%，p<0.001）和亚洲人（18.0%比 2.8%，p<0.001）则较少。SSc-PAH 组的 Charlson 合并症指数较高（3.42 比 2.94，p 值<0.001）。SSc-PAH 组的死亡率调整后比值比（aOR）更高（aOR：1.39，p<0.001），住院时间延长（6.64 比 6.0 天，p<0.001），总住院费用增加（83813 美元比 71016 美元，p <0.001）。对于 SSc-PAH 组，心力衰竭（aOR 3.13）、呼吸机需求（aOR 2.15）、心脏骤停（aOR 1.39）、肾功能衰竭（aOR 1.63）、肺栓塞（aOR 1.84）、心房扑动（aOR 1.86）、心房颤动（aOR1.56）和肺炎（aOR 1.22）的几率也明显较高。没有注意到室性颤动、败血症或呼吸衰竭的显著差异。
与没有肺动脉高压的硬皮病患者相比，硬皮病合并肺动脉高压患者的死亡率和发病率以及医疗保健负担更高，预后更差。此外，肺动脉高压不成比例地影响白种人、非裔美国人和亚洲人群。仍迫切需要继续努力，以便早期诊断和治疗硬皮病患者的肺动脉高压。
