Digital gangrene in systemic sclerosis: prevalence, associated factors and all-cause mortality in a hospitalized cohort from southern China
Abstract
Objectives: To investigate the cohort-specific prevalence of and factors associated with digital gangrene at baseline in systemic sclerosis (SSc), and to evaluate the incidence of gangrene and the association of baseline gangrene with all-cause mortality during follow-up.
Methods: This retrospective cohort included consecutive hospitalized SSc patients (2019–2024) fulfilling 2013 ACR/EULAR criteria. Logistic regression was used to evaluate factors associated with gangrene ever at baseline. For follow-up analyses, exploratory univariable Cox regression was used to assess factors associated with incident gangrene, while multivariable Cox regression evaluated the association between gangrene ever and all-cause mortality.
Results: Of 395 patients at baseline, 41 (10.4%) had gangrene ever and 100 (25.3%) had digital ulcers (DUs) ever. In multivariable logistic regression, DUs ever (OR 21.63, 95% CI 9.32–58.20) and age (OR 1.05 per year, 95% CI 1.01–1.09) were independently associated with gangrene. Among 334 patients at risk (median follow-up 2.0 years), 10 (3.0%) developed incident gangrene (1.24 per 100 patient-years). In exploratory univariable Cox analyses, prior gangrene, DUs ever and DUs at baseline were associated with incident gangrene. During a median 2.08-year follow-up among 356 patients, 82 deaths (23.0%) occurred. In multivariable Cox analysis, gangrene ever did not show a clear independent association with all-cause mortality.
Conclusion: In this hospitalized SSc cohort, DUs ever were strongly associated with gangrene. Furthermore, prior gangrene and DUs identified patients at higher risk for subsequent gangrene events. However, gangrene ever did not show a clear independent association with all-cause mortality.
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BibTeX
@article{wang2026digital,
title = {{Digital gangrene in systemic sclerosis: prevalence, associated factors and all-cause mortality in a hospitalized cohort from southern China}},
author = {Xu Wang and Zufei Xiang and Jie Pan and Wanling Wei and Fang Qin and Fei Dong and Ling Lei},
journal = {Rheumatology Advances in Practice},
year = {2026},
month = aug,
doi = {10.1093/rap/rkag097},
url = {https://doi.org/10.1093/rap/rkag097},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Digital gangrene in systemic sclerosis: prevalence, associated factors and all-cause mortality in a hospitalized cohort from southern China
AU - Xu Wang
AU - Zufei Xiang
AU - Jie Pan
AU - Wanling Wei
AU - Fang Qin
AU - Fei Dong
AU - Ling Lei
PY - 2026
DA - 2026/08/12
JO - Rheumatology Advances in Practice
DO - 10.1093/rap/rkag097
UR - https://doi.org/10.1093/rap/rkag097
AB - Objectives: To investigate the cohort-specific prevalence of and factors associated with digital gangrene at baseline in systemic sclerosis (SSc), and to evaluate the incidence of gangrene and the association of baseline gangrene with all-cause mortality during follow-up. Methods: This retrospective cohort included consecutive hospitalized SSc patients (2019–2024) fulfilling 2013 ACR/EULAR criteria. Logistic regression was used to evaluate factors associated with gangrene ever at baseline. For follow-up analyses, exploratory univariable Cox regression was used to assess factors associated with incident gangrene, while multivariable Cox regression evaluated the association between gangrene ever and all-cause mortality. Results: Of 395 patients at baseline, 41 (10.4%) had gangrene ever and 100 (25.3%) had digital ulcers (DUs) ever. In multivariable logistic regression, DUs ever (OR 21.63, 95% CI 9.32–58.20) and age (OR 1.05 per year, 95% CI 1.01–1.09) were independently associated with gangrene. Among 334 patients at risk (median follow-up 2.0 years), 10 (3.0%) developed incident gangrene (1.24 per 100 patient-years). In exploratory univariable Cox analyses, prior gangrene, DUs ever and DUs at baseline were associated with incident gangrene. During a median 2.08-year follow-up among 356 patients, 82 deaths (23.0%) occurred. In multivariable Cox analysis, gangrene ever did not show a clear independent association with all-cause mortality. Conclusion: In this hospitalized SSc cohort, DUs ever were strongly associated with gangrene. Furthermore, prior gangrene and DUs identified patients at higher risk for subsequent gangrene events. However, gangrene ever did not show a clear independent association with all-cause mortality.
SN - 2514-1775
ER -