Antonietta Gigante1, Anna-Maria Hoffmann-Vold2, Danilo Alunni Fegatelli1, Armando Gabrielli3, Giorgia Leodori1, Bernard Coleiro4, Maria De Santis5, Lorenzo Dagna6, Juan Jose Alegre-Sancho7, Carlomaurizio Montecucco8, Patricia E Carreira9, Alexandra Balbir-Gurman10, Andrea Doria11, Gabriela Riemekasten12, Paolo Airò13, Jörg Distler14, Oliver Distler15, Edoardo Rosato1. 1. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. 2. Department of Rheumatology, Oslo University Hospital, Oslo, Norway. 3. Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università Politecnica delle Marche, University of Ancona, Ancona, Italy. 4. Department of Medicine, Mater Dei Hospital, Msida, Malta. 5. Division of Rheumatology, Clinical Immunology Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy. 6. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Hospital-Vita-Salute San Raffaele University, Milan, Italy. 7. Department of Rheumatology, Hospital Universitario Doctor Peset, Valencia, Spain. 8. Unità Operativa e Cattedra di Reumatología, IRCCS Policlinico San Matteo, Pavia, Italy. 9. Servicio de Reumatología, Hospital 12 de Octubre, Madrid, Spain. 10. B. Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel. 11. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. 12. Department of Rheumatology and Clinical Immunology, University Clinic Schleswig-Holstein, Lübeck, University of Lübeck, Lübeck, Germany. 13. UOC Reumatología ed Immunologia Clinica, Spedali Civili di Brescia, Brescia, Italy. 14. Department of Internal Medicine 3, Universitätsklinikum Erlangen, Erlangen, Germany. 15. Department of Rheumatology, University Hospital, Zürich, Switzerland.
Abstract
OBJECTIVES: The study aim was to evaluate the estimated glomerular filtration rate (eGFR), its association with clinical disease and its predictive ability with respect to mortality in SSc patients from the European Scleroderma Trials and Research Group (EUSTAR) database. METHODS: SSc patients from the EUSTAR database who had items required for the calculation of eGFR at a baseline visit and a second follow-up visit available were included. A cut-off eGFR value of 60 ml/min was chosen for all SSc patients, and 30 ml/min for those with scleroderma renal crisis (SRC). Cox regression and competing risk analysis were performed to evaluate the use of eGFR as a predictive factor of mortality. RESULTS: A total of 3650 SSc patients were included in this study. The median serum level of creatinine and the mean of eGFR were 0.8 mg/dl (interquartile range = 0.6-0.9) and 86.6 ± 23.7 ml/min, respectively. The eGFR was significantly lower in patients with pulmonary hypertension. Overall survival (OS) was significantly reduced in SSc patients with eGFR < 60 ml/min compared with patients with eGFR ≥ 60 ml/min [OS at 5 years 0.763 (95% CI: 0.700, 0.814) vs 0.903 (95% CI: 0.883, 0.919; P < 0.001)]. In multivariable analysis, OS was associated with male gender (P < 0.01), systolic pulmonary arterial pressure (sPAP) (P < 0.001) and eGFR (P < 0.001). The cumulative incidence of deaths due to SSc was associated with increased sPAP (P < 0.001) and reduced eGFR (P < 0.05). The OS at 5 years of 53 SRC patients was not significantly different between SSc patients with eGFR > 30 ml/min and those with eGFR <30 ml/min. CONCLUSION: eGFR represents a predictive risk factor for overall survival in SSc. The eGFR, however, does not represent a risk factor for death in SRC.
OBJECTIVES: The study aim was to evaluate the estimated glomerular filtration rate (eGFR), its association with clinical disease and its predictive ability with respect to mortality in SSc patients from the European Scleroderma Trials and Research Group (EUSTAR) database. METHODS: SSc patients from the EUSTAR database who had items required for the calculation of eGFR at a baseline visit and a second follow-up visit available were included. A cut-off eGFR value of 60 ml/min was chosen for all SSc patients, and 30 ml/min for those with scleroderma renal crisis (SRC). Cox regression and competing risk analysis were performed to evaluate the use of eGFR as a predictive factor of mortality. RESULTS: A total of 3650 SSc patients were included in this study. The median serum level of creatinine and the mean of eGFR were 0.8 mg/dl (interquartile range = 0.6-0.9) and 86.6 ± 23.7 ml/min, respectively. The eGFR was significantly lower in patients with pulmonary hypertension. Overall survival (OS) was significantly reduced in SSc patients with eGFR < 60 ml/min compared with patients with eGFR ≥ 60 ml/min [OS at 5 years 0.763 (95% CI: 0.700, 0.814) vs 0.903 (95% CI: 0.883, 0.919; P < 0.001)]. In multivariable analysis, OS was associated with male gender (P < 0.01), systolic pulmonary arterial pressure (sPAP) (P < 0.001) and eGFR (P < 0.001). The cumulative incidence of deaths due to SSc was associated with increased sPAP (P < 0.001) and reduced eGFR (P < 0.05). The OS at 5 years of 53 SRC patients was not significantly different between SSc patients with eGFR > 30 ml/min and those with eGFR <30 ml/min. CONCLUSION: eGFR represents a predictive risk factor for overall survival in SSc. The eGFR, however, does not represent a risk factor for death in SRC.
Authors: Edward P Stern; Lauren V Host; Ivy Wanjiku; K Jane Escott; Peter S Gilmour; Rachel Ochiel; Robert Unwin; Aine Burns; Voon H Ong; Helen Cadiou; Aidan G O'Keeffe; Christopher P Denton Journal: Arthritis Res Ther Date: 2022-06-01 Impact factor: 5.606