Causes of Death and Poor Survival Prognostic Factors in
Thai Patients with Systemic Sclerosis
SUTAT RUANGJUTIPOPAN, M.D.*, NUNTANA KASITANON, M.D.*,
WORA WIT LOUTHRENOO, M.D.*, WARAPORN SUKITAWUT,B.Sc.*,
RAMJAI WICHAINUN, B.Sc.*
Affiliation : * Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200,
Thailand.
AbstractCauses of death and poor prognostic factors for patients with systemic sclerosis (SSe) were
studied in 222 cases. Their mean age at the onset and duration of disease was 48.9 ± 12.0 years and
23.3 ± 29.3 months, respectively. Fifty-three per cent were diffuse subtype. Patients with diffuse SSe
had more digital pitting scars and more muscle, heart, lung, and esophageal involvement than those
with limited subtypes (p ~ 0.02). One hundred and six patients were lost to follow-up. With a median
follow-up duration of 25 months, 31 of the remaining 116 patients (26.7%) died. SSe related death
occurred in 18 cases, in which the lung, heart and kidney (renal crisis) were the major causes. Infection
contributed to the remaining 13 deaths. When compared with living patients, using a univariate analy
sis, factors associated with a reduced survival rate were age of> 45 years at the onset, diffuse skin
thickness, and lung, gastrointestinal tract, heart, kidney and muscle involvement (p ~ 0.001). In the
multivariate analysis, only age of> 45 years at onset and cardiac involvement remained poor prog
=nostic factors (p 0.04 and 0.001, respectively).
Keywords : Scleroderma, Systemic Sclerosis, Causes of Death, Prognostic Factor, Survival Rate
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