AI Article Synopsis
- - Calciphylaxis is a serious and rare condition with high mortality rates, showing a 6-month mortality of 37.2% and a 1-year rate of 44.1%, especially worse for patients with nephrogenic calciphylaxis.
- - Factors impacting mortality include age and end-stage renal disease, while diabetes was linked to longer hospital stays, and certain treatments like bedside debridement reduced hospitalization time.
- - The study suggests that using nonwarfarin anticoagulation after warfarin can lower death risk; these findings emphasize the need for informed decision-making in care discussions for patients with calciphylaxis.
Article Abstract
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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| http://dx.doi.org/10.1016/j.jaad.2020.10.067 | DOI Listing |
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