Prolonged Capillary Refill Time Indicates Early Nailfold Capillaroscopy in Systemic Sclerosis

Abstract

Objective: Systemic sclerosis (SSc) is a progressive connective tissue disorder that features vascular injury and persistent fibrosis with an autoimmune background. The hypoxic state at the capillary caused by SSc can be assessed with several methods. This study thus investigated the capillary refill time (CRT) effectivity in evaluating peripheral circulation in SSc patients. Method: This prospective, case-control study was conducted with SSc patients and gender and age-matched healthy controls. The CRT measurements were performed by a rheumatologist unaware of patients' records with a smartphone camera in the optimized test ambiance. A video processing software was then applied for the captured videos. Result: 61 patients with SSc and 60 controls participated in this study. According to disease involvement, the patients were then divided into diffuse cutaneous SSc (dSSc) and limited cutaneous SSc. Mainly, CRT was prolonged in the patient group than in the control group. CRT was also prolonged in patients with pathological capillaroscopy patterns in the nail fold capillaroscopy (NFC), below 50 years old, or whose disease duration was over three years. Per disease involvement, patients in the dSSc group with pathologic NFC had prolonged CRT results and higher pulmonary artery pressure levels. The use of CRT for NFC positivity in patients with SSc was practicable (AUC: 0.717;95% CI 0.714-0.942; 83.95% accuracy; 67.9% sensitivity, 100% specificity, 100% positive predictive value, 21.7% negative predictive value, P=0.015) Conclusion: CRT is markedly prolonged in patients with SSc. Evaluating CRT with the NFC positivity may provide pulmonary progression predictable, notably in dSSc patients.

Keywords

• Capillaroscopy
• Capillary refill time
• Pulmonary hypertension
• Systemic sclerosis

Uzamış Kapiller Dolum Süresi, Sistemik Sklerozlu Hastalarda Tırnak Yatağı Kapillaroskopisinin Erken Yapılmasını Vurgular

Abstract

Amaç: Sistemik skleroz (SSk), otoimmün bir arka planda vasküler hasar ve kalıcı fibrozisi içeren ilerleyici bir bağ dokusu hastalığıdır. SSk'nin kapillerdeki sebep olduğu hipoksik durum çeşitli yöntemlerle değerlendirilebilir. Bu çalışma bu nedenle, SSk hastalarında periferik dolaşımı değerlendirmede kapiller dolum zamanının (KDZ) etkinliğini değerlendirmiştir. Metod: Bu prospektif, vaka-kontrol çalışması, SSk hastaları ile cinsiyet ve yaşça eşleştirilmiş sağlıklı kontrollerle yürütülmüştür. KDZ ölçümleri, hasta kayıtlarından bilgisi olmayan bir romatolog tarafından bir akıllı telefon kamerası ile uygun hale getirilmiş bir test ortamında yapıldı. Kayıt edilen videolar için bir video yazılımı uygulandı. Bulgular: 61 SSk hastası ve 60 kontrol bu çalışmaya katıldı. Hastalık tutulumuna göre hastalar diffüz kutanöz SSk (dkSSk) ve limitli kutanöz SSk olarak ikiye ayrıldı. Esasen, KDZ hasta grubunda kontrol grubuna göre uzamıştı (p = 0.003). KDZ, tırnak yatağı kapilleroskopisi (TYK) patolojik paternde olan 50 yaş altındaki ya da hastalık süresi 3 yıldan fazla olan hastalarda uzamıştı. Hastalık tutulumuyla beraber, TYK’si patolojik olan dkSSk grubundaki hastalarda KDZ sonuçları uzamıştı ve pulmoner arter basıncı seviyeleri daha yüksekti. SSk'lı hastalarda TYK pozitifliği için KDZ kullanımı uygulanabilirdi (AUC: 0.717;95% CI 0.714-0.942; 83.95% doğruluk; 67.9% duyarlılık, 100% özgüllük, 100% pozitif prediktif değer, 21.7% negatif prediktif değer, P=0.015) Sonuç: SSk'lı hastalarda KDZ belirgin şekilde uzamaktadır. KDZ'nin TYK pozitifliği ile değerlendirilmesi, özellikle dkSSk hastalarında pulmoner progresyonun öngörülebilir olmasını sağlayabilir.

Keywords

• Kapilleroskopi
• Kapiller dolum zamanı
• Pulmoner hipertansiyon
• Sistemik skleroz

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