Clinical predictors of mortality in critically ill systemic sclerosis patients: a 6-year retrospective cohort study.

Abstract

This study examines clinical predictors of 28-day mortality in critically ill systemic sclerosis (SSc) patients. A retrospective cohort study was conducted on SSc patients in the ICU from 2016 to 2021. Data was gathered on both outpatient and ICU admissions. The primary outcome was 28-day mortality, with secondary outcomes including the incidence of acute complications and organ failure during hospitalization. In a total of 79 ICU admissions for SSc, diffuse cutaneous SSc was identified in 65 patients (82.3%). Of these, 65 (82%) had interstitial lung disease (ILD), 31 (39.2%) had pulmonary hypertension and 20 (25.3%) had cardiac involvement. Leading causes for ICU admission were pneumonia (29.1%), heart failure (26.6%) and septic shock (15.2%). Active organ involvement specific to SSc included active carditis (25.3%), renal crisis (13.9%), ILD progression (7.6%) and pulmonary hypertension associated with right ventricular (RV) failure (6.3%). The 28-day mortality rate was 39.2% (95%CI 28.4-50.9). The higher mortality rate was associated with a higher modified Rodnan skin score (HR 1.11, 95%CI 1.06-1.16), higher SOFA score at ICU admission (HR 1.28, 95%CI 1.16-1.41) and pulmonary hypertension-associated RV failure (HR 10.2, 95%CI 2.93-35.2). Increased 28-day mortality in critically ill SSc patients is notably linked with higher modified Rodnan skin score and SOFA score at ICU admission, as well as pulmonary hypertension-related right ventricular failure.