Analysis of clinical features and prognostic factors in Chinese patients with rheumatic diseases in an intensive care unit

Wang, Meiying; Su, Shengyuan; Lv, Jiyang; Zhou, Gengmin; Wang, Qingwen; Guo, Chengshan

doi:10.1016/j.ejr.2017.05.003

Cited by 9 publications

(4 citation statements)

References 23 publications

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“…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…”

Section: Resultsmentioning

confidence: 99%

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

Suárez-Avellaneda

Quintana

Aragón

et al. 2020

Lupus

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Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%–78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Twelve studies described the clinical characteristics and prognosis of patients with ADs in the ICU, 14, 15, 17, 20, 21, 33–36, 38, 40, 49 10 of which identified SLE as the main cause of admission, ranging from 27% 33, 40 to 54.2%. 15 The systematic review realized by Quintero et al.…”

Section: Resultsmentioning

confidence: 99%

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

Suárez-Avellaneda

Quintana

Aragón

et al. 2020

Lupus

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“…Despite different immunological mechanisms and clinical manifestations, rheumatology patients are often characterized by chronic inflammation, multiorgan involvement, and acute exacerbation (flareup) [1,2]. Among all hospitalized rheumatology patients, up to one third need admission to intensive care unit (ICU) [1] while mortality rates are highly variable (from 16-80%), depending on underlying systemic rheumatic diseases (SRDs), reasons of ICU admission, severity of acute illness, and organ involvement/dysfunction [3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Both multicenter [3] and single-center [4][5][6][7][8][9][10][11][12] studies have been performed among rheumatology patients admitted to the ICU during the past two decades, reporting characteristics and clinical outcome in patients with all forms [3][4][5][6][7][8][9][10] or a specific form of SRDs [11,12]. However, only one study focused on rheumatology patients admitted to ICU due to ARF [7].…”

Section: Introductionmentioning

confidence: 99%

Etiologies and Outcomes of Rheumatology Patients with Acute Respiratory Failure Requiring Intensive Care: A Single-Center Cohort Study of 259 Patients

Shi

Qin

et al. 2020

Preprint

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Background: The etiologies of acute respiratory failure (ARF) in critically ill rheumatology patients remain unknown. We aimed to describe the clinical features, etiologies and outcomes of adult patients with systemic rheumatic diseases (SRDs) who were admitted to intensive care unit (ICU). Methods: We performed a retrospective study of all SRD patients with ARF who were admitted to a medical ICU between 2014 and 2018. We collected data on demographics, clinical characteristics, reasons for ICU admission and outcomes. Etiologies of ARF were classified as infection, SRD exacerbation, and undetermined. Independent predictors of ICU mortality were identified with multivariate logistic regression analysis. Results: A total of 259 patients admitted to ICU due to ARF were included in final analysis. Systemic lupus erythematosus, dermatomyositis/polymyositis (DM/PM), vasculitis and rheumatoid arthritis were the most common SRDs (78% of patients). Etiologies of ARF included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). One hundred and fifty-five patients (59.8%) died during ICU. Higher acute physiology and chronic health evaluation II score (odds ratio [OR] 1.118, 95% confidence interval [CI] 1.054 to 1.186, p < 0.001) and PaO2/FiO2 < 100 mmHg (OR 3.918, 95% CI 2.199 to 6.892, p < 0.001), DM/PM (OR 4.898, 95% CI 1.949 to 12.309, p = 0.001), vasculitis (OR 3.007, 95% CI 1.237 to 7.309, p = 0.015) and Pneumocystis pneumonia (OR 2.345, 95% CI 1.168 to 4.705, p = 0.016) were independent predictors of ICU mortality. Conclusions: Opportunistic infections and SRD exacerbation were the most common etiologies of ARF in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this group of immunocompromised patients might help initiate definitive therapy and improve clinical outcome. Keywords: Infection, Systemic rheumatic disease, Acute respiratory failure, Etiology

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Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients

Shi

Qin

et al. 2020

Clin Rheumatol

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Analysis of clinical features and prognostic factors in Chinese patients with rheumatic diseases in an intensive care unit

Cited by 9 publications

References 23 publications

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

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

Etiologies and Outcomes of Rheumatology Patients with Acute Respiratory Failure Requiring Intensive Care: A Single-Center Cohort Study of 259 Patients

Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients

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