Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

Abstract

Objective: Describe the clinical and epidemiologic characteristics of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU). Methods: a retrospective study with medical records review of patients with systemic lupus erythematosus (SLE) admitted to the ICU between 2004 and 2015 were included. Qualitative variables were described using absolute and relative frequencies. For quantitative variables mean value and standard deviation (SD) or median value with the interquartile range (IQR) depending on data distribution. To compare groups, it was used the Student t-test or Mann Whitney U test as appropriate and Fisher's exact test. Results: 33 patients were included, with a total of 45 ICU admissions, 29 (87.9%) were females with a median age of 26 years. The median time of diagnosis of SLE was two years, (IQR 1.5-5). The most common SLE manifestation and comorbidity were renal disease and hypertension with 27 (81.8%) and 14 (42.4%) respectively. The main reason for admittance was lupus flare with 25 events (55.5%). Infection was the second cause of admission with 19 events (42.2%). The median stay time in the ICU was four days (IQR 2-7). LODS score was 6 (RIQ 5-8), and APACHE II score was 13 (RIQ 11-17.7). There were 29 infections (64.5%) of which 20 (69%) were hospital-acquired. Four (12.1%) patients died. Conclusion: Unlike most of the previously reported series, in this study SLE activity was the most common cause of admission in the ICU. A more aggressive disease and difficulties in the ambulatory setting could explain this behavior. Despite the higher percentage of lupus flares, there was lower mortality.

Causes of Hospitalization for Systemic Lupus Erythematosus in Saudi Arabia Compared With the Global Setting: A Retrospective Single-center Observational Study

“…Most of the ICU patients had disease flare versus infection, which was similar to observations by Alvarez Barreneche et al [22]. Other studies have also indicated infection as the main cause of ICU admission among SLE patients [23,24].…”

Systemic lupus erythematosus in the intensive care unit: a systematic review

“…Overall, these 35 studies comprise a total of 8158 patients. 8, 14–18, 20, 21, 23, 25, 26, 29–52 The largest cohort was retrieved from a public database, including 34,991 admissions of patients with SLE admitted to the ICU. 52…”

“…Glucocorticoids are the most prescribed immunosuppressive agents (>40%). 16, 39, 46, 53 Other immunosuppressive agents which are used less frequently in the ICU are CYC, MMF, rituximab and methotrexate. 20, 39, 80, 81 Moreover, the use of intravenous immunoglobulin (IVIg) has recently increased in patients with SLE, mainly in those who are refractory to conventional management.…”

Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit

“…In a Colombian study, SLE activity was reported to be the leading cause of ICU admission, possibly due to severe disease phenotypes. 9 Indeed, racial and ethnic differences have recently been analyzed by the California Lupus Surveillance Project, and it was found that Hispanic patients showed an increased risk of developing severe manifestations such as LN, thrombocytopenia, and APS earlier than Caucasian patients following an SLE diagnosis. 23 The main complication of SLE at admission was LN, with a considerable percentage of patients requiring renal replacement therapy.…”

“…4 A previous Colombian study showed that SLE activity was the main cause of admission to the ICU in patients with SLE. 9…”