In this retrospective study, we described demographic information, reasons for admission, APACHE II severity scores, complications, mortality rate, causes of death and prognostic factors in 61 Thai patients with systemic lupus erythematosus (SLE) who were admitted to the medical intensive care unit (ICU) over a six-year period. The overall mortality rate during ICU hospitalization was 57% and the most common cause of death was infection, especially in the lower respiratory tract. The mean (SD) APACHE II score was 24.8 (10.8). SLE patients who had an APACHE II score of 20 or more were up to 65% of the patient population and had a significantly lower probability of survival based on Kaplan-Meier results (p = 0.004). The need for vasopressor therapy was significantly higher in patients who did not survive (OR = 6.98, 95% CI = 1.91-25.49). The patients who developed ventilator-associated pneumonia had a numerically higher mortality, which was not statistically significant (OR = 4.17, 95% CI = 0.91-19.03). The use of azathioprine as a steroid-sparing agent for SLE was associated with lower mortality rates (OR = 0.08, 95% CI = 0.01-0.58). Our findings emphasize that Thai SLE patients admitted to the medical ICU has a high mortality rate and early aggressive treatments are warranted.
<p><strong>Objective</strong>. We aimed to investigate the causes and factors predictive of in-hospital death among patients with systemic lupus erythematosus (SLE) admitted to a tertiary care hospital in Thailand.</p><p><strong>Materials and Methods</strong>. We retrospectively reviewed the records of patients with SLE admitted between 2017 and 2021. We collected data related to age, sex, body mass index, comorbidities, disease duration, medication usage, clinical symptoms, vital signs, laboratory results, evidence of infection, presence of systemic inflammatory response syndrome, quick sepsis-related organ assessment scores, and SLE disease activity on the date of admission. The length of hospitalization, treatment administered, and subsequent clinical outcomes (including in-hospital complications and death) were also recorded.</p><p><strong>Results</strong>. Among 267 enrolled patients, the overall in-hospital mortality rate was 25.5%, and infection was the most common cause of death (75.0%). Multivariate analysis revealed that prior hospitalization within 3 months (odds ratio [OR]: 2.311; 95% confidence interval [CI]: 1.002–5.369; P=0.049), initial infection on admission (OR: 2.764; 95% CI: 1.006–7.594; P=0.048), use of vasopressor drugs (OR: 2.940; 95% CI: 1.071–8.069; P=0.036), and mechanical ventilation (OR: 5.658; 95% CI: 2.046–15.647; P=0.001) were independent risk factors for in-hospital mortality.</p><p><strong>Conclusion</strong>. Infection was the major cause of mortality in patients with SLE. Prior hospitalization within 3 months, initial infection on admission, vasopressor use, and mechanical ventilation during admission are independent risk factors for in-hospital mortality in patients with SLE.</p>
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