Pericardial Effusions and Cardiac Tamponade in Hospitalized Systemic Sclerosis Patients: Analysis of the National Inpatient Sample

Abstract Introduction: Clinically significant pericardial effusions and cardiac tamponade in systemic sclerosis (SSc) patients is uncommon and the factors that contribute to progression of pericardial involvement in SSc patients have not been well established. Methods: A review of the national inpatient sample database was performed looking SSc related hospitalizations between 2002-2019. Data was collected on patients with pericardial effusions and cardiac tamponade and analyzed to identify and describe patient characteristics and comorbidities. Results: Out of a total of 523,410 SSc hospitalizations, with an overall inpatient mortality rate of 4.7% (24,764 patients), pericardial effusion was identified in 3.1% of all hospitalizations (16,141 patients) out of which 0.2% (838 patients) had a diagnosis of cardiac tamponade. Patients with pericardial effusion were significantly more likely to have pulmonary circulatory disease (p= <0.0001), congestive heart failure (p= <0.0001) end stage renal disease (p= <0.0001), diabetes (p= 0.015), and hypothyroidism (p= 0.025). Patients with cardiac tamponade were significantly more likely to have a history of coronary artery bypass graft surgery (p= 0.001), peripheral vascular disease (p= <0.0001) or atrial fibrillation (p= <0.0001). Hospitalized patients with cardiac tamponade had a significantly increased mortality rate of 17.7% compared to 8.8% in patients with pericardial effusions without a tamponade physiology, with an odds ratio of 2.3 (1.97-2.86), p= <0.0001. Conclusion: Pericardial effusion and tamponade are associated with increased morbidity and mortality in SSc patients. Further studies are required to explore the role of patient comorbidities and characteristics in development into pericardial effusions or tamponade.