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High risk of gastrointestinal hemorrhage in patients with systemic sclerosis
Arthritis Research & Therapy ( IF 4.9 ) Pub Date : 2019-12-26 , DOI: 10.1186/s13075-019-2078-5
Yi-Ting Lin , Yun-Shiuan Chuang , Jiunn-Wei Wang , Ping-Hsun Wu

Systemic sclerosis (SSc), a life-threatening autoimmune disease characterized by vasculopathy. Numerous SSc patients demonstrate gastrointestinal (GI) involvement but the delicate GI bleeding risk remains sparse. We aimed to explore the role of SSc in determining the long-term risk of GI bleeding, including bleedings of upper (peptic and non-peptic ulcers) and lower GI tracts. Patients with SSc diagnosis were identified from the Catastrophic Illness Patient Database and the National Health Insurance Research Database from 1998 to 2007. Each SSc patient was matched with five SSc-free individuals by age, sex, and index date. All individuals (case = 3665, control = 18,325) were followed until the appearance of a GI bleeding event, death, or end of 2008. A subdistribution hazards model was assessed to evaluate the GI bleeding risk with adjustments for age, sex, and time-dependent covariates, comorbidity, and medications. The incidence rate ratios of GI bleeding were 2.38 (95% confidence interval [CI], 2.02–2.79), 2.06 (95% CI, 1.68–2.53), and 3.16 (95% CI, 2.53–3.96) for over-all, upper, and lower GI bleeding events in SSc patients. In the competing death risk in the subdistribution hazards model with time-covariate adjustment, SSc was an independent risk factor for over-all GI bleeding events (subdistribution hazard ratio [sHR] 2.98, 95% CI, 2.21–4.02), upper GI bleeding events (sHR 2.80, 95% CI, 1.92–4.08), and lower GI bleeding events (sHR 3.93, 95% CI, 2.52–6.13). SSc patients exhibited a significantly higher risk of over-all and different subtype GI bleeding events compared with the SSc-free population. The prevention strategy is needed for these high GI bleeding risk groups.

中文翻译:

系统性硬化症患者胃肠道出血的高风险

系统性硬化症(SSc),一种以血管病变为特征的危及生命的自身免疫性疾病。许多 SSc 患者表现出胃肠道 (GI) 受累,但脆弱的胃肠道出血风险仍然很少。我们的目的是探讨 SSc 在确定胃肠道出血的长期风险中的作用,包括上消化道(消化性和非消化性溃疡)和下消化道出血。诊断为 SSc 的患者是从 1998 年至 2007 年的灾难性疾病患者数据库和国家健康保险研究数据库中确定的。每位 SSc 患者根据年龄、性别和指数日期与 5 名无 SSc 的个体相匹配。对所有个体(病例 = 3665,对照 = 18,325)进行随访,直到出现胃肠道出血事件、死亡或 2008 年底。评估了亚分布风险模型,以评估胃肠道出血风险,并调整年龄、性别和时间-依赖的协变量、合并症和药物。总体而言,胃肠道出血的发生率比分别为 2.38(95% 置信区间 [CI],2.02–2.79)、2.06(95% CI,1.68–2.53)和 3.16(95% CI,2.53–3.96)。 SSc 患者的上消化道和下消化道出血事件。在经过时间协变量调整的次分布风险模型中的竞争性死亡风险中,SSc 是整体胃肠道出血事件的独立危险因素(次分布风险比 [sHR] 2.98,95% CI,2.21–4.02)、上消化道出血事件(sHR 2.80,95% CI,1.92-4.08)和较低的胃肠道出血事件(sHR 3.93,95% CI,2.52-6.13)。与无 SSc 人群相比,SSc 患者发生总体和不同亚型胃肠道出血事件的风险显着更高。这些胃肠道出血高危人群需要采取预防策略。
更新日期:2019-12-27
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