期刊
ARTHRITIS RESEARCH & THERAPY
卷 19, 期 -, 页码 -出版社
BMC
DOI: 10.1186/s13075-017-1341-x
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类别
资金
- Scleroderma Australia
- Arthritis Australia
- Actelion Australia
- Bayer, CSL
- Biotherapies
- GlaxoSmithKline Australia
- Pfizer
- NHMRC Scholarship [APP1113954]
- NHMRC Fellowship [APP1071735]
Background: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). We sought to determine survival, predictors of mortality, and health-related quality of life (HRQoL) related to PAH in a large SSc cohort with PAH. Methods: We studied consecutive SSc patients with newly diagnosed (incident) World Health Organization (WHO) Group 1 PAH enrolled in a prospective cohort between 2009 and 2015. Survival methods were used to determine age and sex-adjusted standardised mortality ratio (SMR) and years of life lost (YLL), and to identify predictors of mortality. HRQoL was measured using the Short form 36 (SF-36) instrument. Results: Among 132 SSc-PAH patients (112 female (85%); mean age 62 +/- 11 years), 60 (45.5%) died, with a median (+/- IQR) survival time from PAH diagnosis of 4.0 (2.26.2) years. Median (+/- IQR) follow up from study enrolment was 3.8 (1.6 5.8) years. The SMR for patients with SSc-PAH was 5.8 (95% CI 4.3 7.8), with YLL of 15.2 years (95% CI 12.3 18.1). Combination PAH therapy had a survival advantage (p < 0.001) compared with monotherapy, as did anticoagulation compared with no anticoagulation (p < 0.003). Furthermore, combination PAH therapy together with anticoagulation had a survival benefit compared with monotherapy with or without anticoagulation and combination therapy without anticoagulation (hazard ratio 0.28, 95% CI 0.1 0.7). Older age at PAH diagnosis (p = 0.03), mild co-existent interstitial lung disease (ILD) (p = 0.01), worse WHO functional class (p = 0.03) and higher mean pulmonary arterial pressure at PAH diagnosis (p = 0.001), and digital ulcers (p = 0.01) were independent predictors of mortality. Conclusions: Despite the significant benefits conferred by advanced PAH therapies suggested in this study, the median survival in SSc PAH remains short at only 4 years.
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