Retrospective Cohort Study Of Cardiovascular Events In Primary Sj(?)gren’s Syndrome

Objective:This study established a retrospective cohort of primary Sj(?)gren’s syndrome(pSS)to explore the cumulative incidence of adverse cardiovascular events and the overall survival rate in patients with pSS,and to analyze the related predictors of adverse cardiovascular events and all-cause death in patients with pSS.Methods:The patients with pSS diagnosed in Chengdu Third People’s Hospital from April 2011 to August 2020 were consecutively enrolled,and a retrospective study cohort of pSS patients was established.Baseline clinical data of pSS patients were collected,and patients were followed up to obtain follow-up data.Follow-up endpoints were the occurrence of adverse cardiovascular events,including cardiac death and serious cardiovascular disease(recurrent myocardial infarction,acute heart failure,lethal heart rhythm disorders,and cardiogenic shock),and all-cause death.The Kaplan-Meier method was used to analyze the cumulative incidence of adverse cardiovascular events and overall survival in pSS patients;the Log-rank test was used to evaluate the differences in the cumulative incidence of adverse cardiovascular events and cumulative survival rate among pSS patients with different characteristics;univariate and multivariate Cox regression models were used to explore the related predictors of adverse cardiovascular events and all-cause death in the baseline clinical indicators of pSS patients.Results:A total of 190 patients with pSS were included in this study.During the follow-up period,12 patients(6.3%)had adverse cardiovascular events,of which 9 patients(4.73%)had cardiac death,and 28 patients(14.7%)had all-cause death.Twelve patients with cardiovascular disease and 19 patients with non-cardiac death were excluded,a total of 159 patients with pSS were included in the analysis of adverse cardiovascular events,including 12 pSS patients with adverse cardiovascular events and 147 pSS patients without cardiovascular events.(1)In descriptive statistics of baseline clinical data,compared with pSS patients without cardiovascular events,pSS patients with adverse cardiovascular events were older[59(50-71)years vs.78(71-81)years,P<0.001],serum creatinine[61.7(54.30-74.20)μmol/L vs.71.9(61.04-107.28)μmol/L,P=0.038]and urea[5.03 ± 1.57 mmol/L vs.7.47 ± 3.54 mmol/L,P=0.037]had higher levels,and the proportion of hypertension(29.9%vs.66.7%,P=0.022),anemia(25.2%vs.58.3%,P=0.033),and hypoalbuminemia(18.4%vs.58.3%,P=0.004)were higher.(2)The 3-year and 5-year cumulative incidence of adverse cardiovascular events in pSS patients were 7.2%and 11.2%,respectively.(3)The cumulative incidence of adverse cardiovascular events in pSS patients aged≥60 years was higher than that in pSS patients aged<60 years[HR=11.387,95%CI(1.468-88.347),P=0.003],and the cumulative incidence of adverse cardiovascular events in pSS patients with hypertension was higher than patients without hypertension[HR=4.443,95%CI(1.335-14.784),P=0.008].(4)Univariate Cox regression analysis showed that age,hypoalbuminemia,anemia,creatinine,urea,and hypertension were risk factors for adverse cardiovascular events in patients with pSS(P<0.05).(5)Multivariate Cox regression models showed that age[HR=1.115,95%CI(1.038-1.199),P=0.003]and hypoalbuminemia[HR=4.574,95%CI(1.424-14.690),P=0.011]were related predictors of adverse cardiovascular events in pSS patients.A total of 190 pSS patients were included in the analysis of all-cause death,28 pSS patients had all-cause death and 162 pSS patients were included in the survival group.(1)In descriptive statistics of baseline clinical data,compared with pSS patients in survival group,pSS patients in all-cause death group were older[62(51-72)vs.74(65-80),P<0.001],serum creatinine[62.4(55.05-76.25)μmol/L]vs.84.4(63.15-135.43)μmol/L,P<0.001]and urea[5.06(4.05-5.82)mmol/L vs.6.29(5.39-9.90)mmol/L,P<0.001]levels were higher,and there were patients with smoking history[5.6%vs.21.4%,P=0.013],as well as pulmonary fibrosis(8.0%vs.28.6%,P=0.004),anemia(24.1%vs.67.9%,P<0.001)and hypoalbuminemia(17.9%vs.50.0%,P=0.001)accounted for a larger proportion.(2)The 3-year and 5-year overall survival rate of pSS patients were 87.9%and 84.1%,respectively.(3)The cumulative survival rate of pSS patients aged≥60 years was higher than pSS patients aged<60 years[HR=4.891,95%CI(1.695-14.111),P=0.001].The cumulative survival rate of male was higher than female patients[HR=2.546,95%CI(1.029-6.297),P=0.036].The cumulative survival rate of pSS patients with smoking history was higher than pSS patients without smoking history[HR=3.115,95%CI(1.259-7.707),P=0.009].(4)Univariate Cox regression analysis showed that age,male,smoking,pulmonary fibrosis,hypoalbuminemia,anemia,serum creatinine and urea were all risk factors for all-cause death(P<0.05).(5)Multivariate Cox regression models showed age[HR=1.082,95%CI(1.036-1.130),P<0.001],male[HR=3.153,95%CI(1.205-8.250),P=0.019],pulmonary fibrosis[HR=3.465,95%CI(1.428-8.408),P=0.006],hypoalbuminemia[HR=3.334,95%CI(1.390-7.997),P=0.007]and anemia[HR=5.288,95%CI(2.170-12.883),P<0.001]were related predictors of all-cause death.Conclusion:The 3-year and 5-year cumulative incidence of cardiovascular events in pSS patients were 7.2%and 11.2%,respectively.Age and hypoalbuminemia were related predictors of adverse cardiovascular events in pSS patients.The 3-year and 5-year overall survival rate of pSS patients were 87.9%and 84.1%,respectively.Age,male,pulmonary fibrosis,hypoalbuminemia,and anemia were related predictors of all-cause death in pSS patients.