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Assessment of outcomes of calciphylaxis
Colleen K Gabel1, Emily D Nguyen2, Teja Chakrala3
1Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Calciphylaxis, a rare vasculopathy, has high mortality. Non-nephrogenic calciphylaxis patients show better survival, and anticoagulation may reduce death risk. This aids in care discussions.
Area of Science:
- Nephrology
- Vascular Medicine
- Dermatology
Background:
- Calciphylaxis is a rare, severe thrombotic vasculopathy with high morbidity and mortality.
- Limited studies exist on the long-term outcomes of calciphylaxis patients.
Purpose of the Study:
- To evaluate mortality rates, hospitalization duration, and amputation incidence in calciphylaxis patients.
- To identify risk factors associated with adverse outcomes in calciphylaxis.
Main Methods:
- Retrospective review of medical records for 145 patients diagnosed with calciphylaxis.
- Data collected from January 2006 to December 2018 at an urban tertiary care hospital.
Main Results:
- Six-month and 1-year mortality rates were 37.2% and 44.1%, respectively.
- Nephrogenic calciphylaxis was associated with worse survival, but this difference diminished when focusing on calciphylaxis-specific deaths.
- End-stage renal disease and older age were risk factors for 1-year mortality; diabetes mellitus increased hospitalization days, while bedside debridement decreased them.
- Anticoagulation with warfarin transitioning to non-warfarin agents correlated with a reduced hazard of death.
Conclusions:
- Calciphylaxis is a complex, heterogeneous condition.
- Patients with non-nephrogenic calciphylaxis experience lower mortality.
- Findings can inform shared decision-making regarding goals of care for calciphylaxis patients.
Background:
Calciphylaxis is a rare thrombotic vasculopathy characterized by high morbidity and mortality. There is a paucity of studies examining longitudinal outcomes.
Objective:
To assess mortality, days spent in the hospital, and amputations in patients with calciphylaxis.
Methods:
A retrospective medical record review was conducted in 145 patients diagnosed with calciphylaxis at an urban tertiary care hospital from January 2006 to December 2018.
Results:
Six-month mortality was 37.2%, and 1-year mortality was 44.1%. Patients with nephrogenic calciphylaxis had worse survival than those with nonnephrogenic calciphylaxis (P = .007). This difference in survival disappeared when limiting mortality to deaths due to calciphylaxis. Age (P = .003) and end-stage renal disease (P = .01) were risk factors associated with 1-year mortality. Diabetes mellitus was associated with greater total hospitalization days (coefficient, 1.1; 95% confidence interval, 1.01-1.4); bedside debridement was associated with fewer hospitalization days (coefficient, 0.8; 95% confidence interval, 0.7-0.9). Amputations were not associated with any of the examined risk factors. The use of warfarin followed by a transition to nonwarfarin anticoagulation was associated with decreased hazard of death (P = .01).
Limitations:
Retrospective nature.
Conclusions:
Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with nonnephrogenic disease. These findings may be incorporated during discussions regarding the goals of care to facilitate informed shared decision making.
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