Incidence and risk factors for gangrene in patients with systemic sclerosis from the EUSTAR cohort

Carina Mihai*, Oliver Distler, Ana Maria Gheorghiu, Paul I. Constantin, Rucsandra Dobrota, Suzana Jordan, Vanessa Smith, Eric Hachulla, Jörg Henes, Elise Siegert, Serena Vettori, Ulf Müller-Ladner, Marco Matucci Cerinic, Yannick Allanore, Gemma Lepri, Veronika K. Jaeger, Ulrich A. Walker, Florenzo Iannone, Fabio Cacciapaglia, Michal TomčíkRadim Becvar, Simona Rednic, Ana Petcu, Iulia Szabo, Veronica Codullo, Roberto Caporali, Carlomaurizio Montecucco, Patricia Carreira, Beatriz Ioven, Tunde Minier, László Czirják, Carlo Chizzolini, Danièle Allali, Elisabetta Zanatta, Andrea Doria, Armando Gabrielli, Paolo Airò, Maria Grazia Lazzaroni, Mislav Radić, Duska Martinovic, Yolanda Braun-Moscovici, Alexandra Balbir-Gurman, Nicolas Hunzelmann, Paola Caramaschi, Jadranka Morovic-Vergles, Christopher Denton, Vera Ortiz Santamaria, Stefan Heitmann, Dorota Krasowska, Malgorzata Michalska-Jakubus, Matthias Seidel, Ivan Foeldvari, Nicola Helmus, Maria João Salvador, Bojana Stamenkovic, Aleksandra Stankovic, Lidia Ananieva, Ariane Herrick, Merete Engelhart, Carlos De La Puente, Anna Maria Hoffmann-Vold, Øyvind Midtvedt, David Launay, Vincent Sobanski, Valeria Riccieri, Daniela Opris-Belinski, Laura Groseanu, Ruxandra Maria Ionescu, Mihai Bojinca, Cord Sunderkötter, Jörg Distler, Francesca Ingegnoli, Amber Van Der Haecke, Susanne Ullman, Maria Rosa Pozzi, Kilian Eyerich, Marie Vanthuyne, Anne Erler, Martin Aringer, Ellen De Langhe, Marko Baresic, Miroslav Mayer, Branimir Anic, Sule Yavuz, Brigitte Granel, Sergei Popa, Svetlana Agachi, Thierry Zenone, Alessandro Mathieu, Alessandra Vacca, Kamal Solanki, Douglas Veale, Esthela Loyo, Carmen Tineo, Antonetta Gigante, Edoardo Rosato, Fahrettin Oksel, Figen Yagurcu, Cristina Mihaela Tǎnǎseanu, Elisa Visalli, Alessia Benenati, Rosario Foti, Codrina Ancuta, Diana Dan, Sabine Adler, Peter Villiger, Nihal Fathi, Paloma García De La Peña Lefebvre, Jorge Juan González Martín, Emmanuel Chatelus, Jean Sibilia, Ira Litinsky, Francesco Del Galdo, Lesley Ann Sakettkoo, Eduardo Kerzberg, Washington A. Bianchi, Breno Valdetaro Bianchi, Ivan Castellví, Massimiliano Limonta, Doron Rimar, Maura Couto, Camillo Ribi, François Spertini, Sarah Kahl, Vivien Hsu, Vincent Poindron, Kilifa Meghit, Thierry Martin, Kathleen Kolstad, Lorinda Chung, Astrid Thiele, Tim Schmeiser, Zbigniew Zdrojewski, Gabriela Riemekasten, Yair Levy, Anca Cardoneanu, Alexandra Burlui, Elena Rezus, Omer Nuri Pamuk, Rossella Talotta, Sara Bongiovanni, Piercarlo Sarzi Puttini

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Objective: In patients with SSc, peripheral vasculopathy can promote critical ischaemia and gangrene. The aim of this study was to investigate the prevalence, incidence and risk factors for gangrene in the EUSTAR cohort. Methods: We included patients from the EUSTAR database fulfilling the ACR 1980 or the ACR/EULAR 2013 classification criteria for SSc, with at least one visit recording data on gangrene. Centres were asked for supplementary data on traditional cardiovascular risk factors. We analysed the cross-sectional relationship between gangrene and its potential risk factors by univariable and multivariable logistic regression. Longitudinal data were analysed by Cox proportional hazards regression. Results: 1757 patients were analysed (age 55.9 [14.5] years, disease duration 7.9 [10.3] years, male sex 16.7%, 24.6% diffuse cutaneous subset [dcSSc]). At inclusion, 8.9% of patients had current or previous digital gangrene, 16.1% had current digital ulcers (DUs) and 42.7% had ever had DUs (current or previous). Older age, DUs ever and dcSSc were statistically significant risk factors for gangrene in the cross-sectional multivariable model. During a median follow-up of 13.1 months, 16/771 (0.9%) patients developed gangrene. All 16 patients who developed gangrene had previously had DUs and gangrene. Further risk factors for incident gangrene were the dcSSc subset and longer disease duration. Conclusion: In unselected SSc patients, gangrene occurs in about 9% of SSc patients. DUs ever and, to a lesser extent, the dcSSc subset are strongly and independently associated with gangrene, while traditional cardiovascular risk factors could not be identified as risk factors.

Original languageEnglish
Pages (from-to)2016-2023
Number of pages8
JournalRheumatology
Volume59
Issue number8
DOIs
StatePublished - 1 Aug 2020

Keywords

  • digital ulcers
  • gangrene
  • systemic sclerosis
  • vasculopathy

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