Increased risk of mortality in systemic sclerosis-associated digital ulcers: a systematic review and meta-analysis

Background Survival can be threatened in certain forms of systemic sclerosis (SSc) so clear prognostic factors are needed. Objectives The aim of this meta-analysis was to assess the association between the presence of digital ulcers (DUs) and mortality in SSc. Methods We performed a systematic review and meta-analysis in the Pubmed and Scopus databases from the earliest records to May 2017. Two research strategies were performed: << systemic sclerosis >> and << digital ulcers >> (strategy A); << systemic sclerosis >> and << mortality >> (strategy B). The primary outcome was the mortality associated with the presence of DUs in patients with SSc. Results The literature search identified 1473 citations. Fifty-nine studies were examined for full text. Ten articles were included for the meta-analysis. SSc patients with DUs had an increased pooled mortality risk: RR = 1.53 (IC 95%: [1.23-1.90]). Conclusions This meta-analysis revealed a higher mortality in SSc patients with associated DUs. Having DUs may be a predictive factor of developing organ involvement such as pulmonary or cardiovascular events that could be associated with poor survival. It suggests that early screening of DUs in SSc patients is important to identify patients most at risk of poor survival.