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Malnutrition is an independent risk factor for mortality in Mexican patients with systemic sclerosis: a cohort study

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Abstract

Factors for mortality in systemic sclerosis (SSc) vary in different cohorts around the world. Case–control study nested in a cohort. We included patients ≥16 years of age with SSc (ACR/EULAR 2013), from 2005 to 2015. Demographic and clinical variables and causes of mortality were recorded. We calculated Crude Mortality Rate (CMR), Standardized Mortality Ratio (SMR), and Kaplan–Meier survival analysis was performed. A Cox proportional hazard (HR) regression analysis of the potential risk factors associated with mortality was also performed. A total of 220 patients with SSc were included. During follow-up, 28 deaths occurred. The sum of total time contributed by all subjects was 1074 years-person, the CMR was 12.72%, the overall SMR was 4.5, in women 3.7, and in men 4.7. The survival rate at 5 and 10 years was 83 and 70%, respectively. The causes of death were definitively attributed to SSc in 21.4% of the cases, probably in 28.7%, unrelated in 35.6%, and unknown in 14.3%. The direct cause of death of the patients was infection in 25% of cases, cardiovascular disease in 14%, lung involvement in 14%, pulmonary embolism in 11%, and neoplasia in 11%. The Cox regression analysis showed that the factors associated with mortality were: male gender (HR 5.84, CI 95% 1.31–26, p = 0.013), severe Medsger’s score for general symptoms (HR 5.12, CI 95% 1.74–14.97, p = 0.021) and severe malnutrition (HR 3.77, CI 95% 1.23–11.06, p = 0.008). Infections, cardiovascular disease, and lung involvement were the leading cause of death. Male gender and severe general affection and malnutrition were associated with a poorer prognosis of SSc.

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Authors and Affiliations

  1. Faculty of Medicine, Research Division, Instituto Mexicano del Seguro Social-Hospital de Especialidades Centro Medico La Raza, Universidad Nacional Autonoma de México, Seris y Zaachila S/N, Col. La Raza, Ciudad De México, 02990, Mexico

    María Pilar Cruz-Domínguez

  2. Hospital de Especialidades Centro Medico La Raza, Instituto Mexicano del Seguro Social-Sección de Estudios de Posgrado e Investigación-Instituto Politécnico Nacional, Escuela Superior de Medicina, Ciudad De México, Mexico

    Grettel García-Collinot

  3. Faculty of Medicine, Rheumatology Department, Hospital de Especialidades Centro Medico La Raza, Instituto Mexicano del Seguro Social, Universidad Nacional Autonoma de México, Ciudad De México, Mexico

    Miguel Angel Saavedra

  4. Hospital General Centro Medico La Raza, Instituto Mexicano del Seguro Social, Emergency Room, Education and Research, Hospital 1º Octubre, ISSSTE, Ciudad De México, Mexico

    Daniel H. Montes-Cortes

  5. Faculty of Medicine, Internal Medicine Department, Hospital de Especialidades Centro Medico La Raza, Instituto Mexicano del Seguro Social, Universidad Nacional Autonoma de México, Ciudad De México, Mexico

    Rubén Morales-Aguilar & Olga L. Vera-Lastra

  6. Hospital de Especialidades Centro Medico La Raza, Instituto Mexicano del Seguro Social, Instituto Politécnico Nacional, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Ciudad De México, Mexico

    Rosa Angélica Carranza-Muleiro

  7. Faculty of Medicine, Direction of Education and Research, Hospital de Especialidades Centro Medico La Raza, Instituto Mexicano del Seguro Social, Universidad Nacional Autonoma de México, Ciudad De México, Mexico

    Luis J. Jara

Authors
  1. María Pilar Cruz-Domínguez
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  2. Grettel García-Collinot
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  3. Miguel Angel Saavedra
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  4. Daniel H. Montes-Cortes
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  5. Rubén Morales-Aguilar
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  6. Rosa Angélica Carranza-Muleiro
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  7. Olga L. Vera-Lastra
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  8. Luis J. Jara
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Corresponding author

Correspondence to María Pilar Cruz-Domínguez.

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This study was not funded.

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All authors have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. This article was obtained by retrolective collection in routine follow-up of a cohort of patients and does not contain any additional studies with human participants or animals performed by any of the authors.

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Cruz-Domínguez, M.P., García-Collinot, G., Saavedra, M.A. et al. Malnutrition is an independent risk factor for mortality in Mexican patients with systemic sclerosis: a cohort study. Rheumatol Int 37, 1101–1109 (2017). https://doi.org/10.1007/s00296-017-3753-y

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