Main Cause of Acute Hospitalization and Mortality Identified in Patients With Systemic Sclerosis

pneumonia, lungs
Researchers studied the causes and predictors of acute hospitalization and in-patient mortality in patients with systemic sclerosis (SSc).

In a cohort of patients with systemic sclerosis (SSc), infection, primarily due to pneumonia, was the main cause of acute hospitalization and mortality, according to study results published in Rheumatology International.

Limited data exist on acute hospitalization patterns in patients with SSc.

The current retrospective cohort study analyzed the causes and predictors of acute hospitalizations in patients with SSc.

The cohort included patients with SSc registered at a single hospital who were identified retrospectively between 2010 and 2020 using hospital medical records and the National Healthcare Registry Platform. The researchers recorded acute hospital admissions and other clinical and patient data.

Of 95 patients in the cohort, 53 had 164 acute hospital admissions. The causes for admission were infectious disease (27%), cardiac disease (16.5%), peripheral vascular disease (12.8%), pulmonary hypertension (9.8%), and interstitial lung disease (ILD; 9.1%).

Among the most common cause of hospitalization, ie, infections, 70% were due to pneumonia, 74% of which were SSc-ILD. In 70.5% of hospitalizations due to infection, patients were receiving treatment with immunosuppressive medications.

Cardiac disease hospitalizations increased over the 10-year study period, while those from ILD decreased over the previous 5 years.

Researchers noted 14 deaths due to pneumonia (36%), heart failure (21%), neoplastic diseases (21%), pulmonary hypertension (14%), and ILD (7%).

Using multivariable analysis, the only variable significantly associated with infection was the number of acute hospitalizations greater than 1 (odds ratio, 2.29; 95% CI, 1.11-4.71; P =.02). Risk factors for both acute hospital admissions and mortality included sex, race, digital ulcers, cardiac dysfunction, ILD, and pulmonary hypertension.

Limitations of the study included the small cohort size, retrospective study design, and the possibility that admissions at other hospitals were missed.

The researchers concluded, “In our cohort, infection was the principal cause of acute hospitalization and of inpatient mortality, mainly due to [pneumonia]. Although a high percentage of those patients had ILD, this disease feature, in our cohort, has been decreasing over the last years as a direct cause of hospital admission and of mortality, probably reflecting the advances in its management.”


Caetano J, Batista F, Amaral MC, Oliveira S, Alves JD. Acute hospitalization in a cohort of patients with systemic sclerosis: a 10‑year retrospective cohort study. Rheumatol Int. Published online September 3, 2021. doi:10.1007/s00296-021-04983-4