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

Aragón, Cristian C.; Ruiz-Ordóñez, Ingrid; Quintana, Jhon H; Suárez-Avellaneda, Ana; Gallego, Linda M; Gallego, Cindy-Natalia; Bolaños, J; Guerra, M; Ochoa, Minerva Lazos; Granados, Marcela; Tobón, Gabriel J.

doi:10.1177/0961203320935176

Cited by 7 publications

(10 citation statements)

References 32 publications

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“…In our analysis, the predictors of mortality were APACHE-II >16, infections, lymphopenia, vasopressor support, and elevated creatinine. Other studies from Asia 17,19 and South America 20,26 also found that vasopressor requirement, hypotension were predictors of mortality. The presence of infections was a strong predictor of mortality in our patients, and the same is also observed by others.…”

Section: Discussionmentioning

confidence: 78%

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Outcome of critically ill patients with systemic lupus erythematosus from a medical intensive care unit in Southern India

Bhargav,

Ramanathan,

Ramadoss

et al. 2023

Lupus

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Objective Systemic lupus erythematosus (SLE) has become the most prevalent autoimmune condition requiring admission in the intensive care units (ICU) in the last two decades. Here we analysed the clinical outcomes of SLE patients admitted to our ICU between 2011 and 2021, and studied the prognostic role of high-density lipoprotein (HDL) and procalcitonin in those enrolled after August 2019. Methods Systemic lupus erythematosus (ACR/SLICC 2012) were enrolled, 72 retrospectively and 30 prospectively. Data on indications for ICU admission, complications, infections, and disease activity were recorded. Outcome was mortality at 90 days (prospective) whereas in the retrospective analysis outcome was hospital discharge or death in hospital. Serum HDL and procalcitonin (PCT) was estimated in the prospectively enrolled 30 patients and compared with 30 non ICU-SLE patients. Results Indications for ICU admissions were respiratory causes in 78/102 (76.5%) patients; for haemodynamic monitoring and for invasive procedures in the remaining. Pneumonia was the primary reason for mechanical ventilation, followed by diffuse alveolar haemorrhage (DAH). Eighty-three (81.3%) patients died; infections ( n = 54) and SLE related causes ( n = 29). APACHE-II >16 ( p = .026), lymphopenia ( p = .021), infection ( p = .002), creatinine >1.3 mg/dL ( p = .023), and hypotension requiring vasopressor support ( p = .006) emerged as significant predictors of non-survival on multivariable analysis. HDL (mg/dL) day 1 was significantly lower in SLE-ICU patients compared to non ICU-SLE (31.8 ± 14.3 vs 38.8 ± 11.4 mg/dl); p = .045. On day 1, PCT (ng/mL) in SLE-ICU was significantly higher when compared to non-ICU SLE; median (IQR): 0.53 (0.26–5.27) versus 0.13 (0.05–0.47), p < .001), respectively. It was also significantly higher on day 5 in SLE-ICU than non-ICU SLE (median (IQR): 4.18 (0.20–14.67) versus 0.10 (0.08–0.46), p = .004. Conclusion The mortality of SLE patients admitted to the ICU in this study is high, and infections were the principal reason for death. Baseline low HDL and higher procalcitonin are potential biomarkers to identify critically ill SLE patients.

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Section: Discussionmentioning

confidence: 78%

“…19,27 Pneumonia was the most common infection, as has been observed in other ICUs. 16,18,19,26,27 A direct comparison of the mortality rate in our study with Indian ICU data (Bharath et al) 27 was also not possible as the authors had not reported the number of SLE patients who were admitted in the ICU and survived. 27…”

Section: Discussionmentioning

confidence: 82%

Outcome of critically ill patients with systemic lupus erythematosus from a medical intensive care unit in Southern India

Bhargav,

Ramanathan,

Ramadoss

et al. 2023

Lupus

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“…However, the value of APACHE II in predicting outcome of patient with SLE admitted to the ICU was inconsistent among different studies. Some studies found that APACHE II was one of the factors to predict in-ICU mortality in patients with SLE (7,8,11,15), while the opposite results were found in other studies (9,12,17). Thus, it is necessary to develop a new prognostic model predicting in-ICU mortality of patients with SLE.…”

Section: Discussionmentioning

confidence: 96%

“…Currently, there are numerous reports regarding the clinical features, outcome, and prognostic factors of patients with SLE admitted to the ICU (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). However, the number of patients was relatively small in the majority of studies, and a scoring system was not established.…”

Section: Introductionmentioning

confidence: 99%

Development of a Novel Simple Model to Predict Mortality in Patients With Systemic Lupus Erythematosus Admitted to the Intensive Care Unit

Guo

Huang

et al. 2021

Front. Med.

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Background: Patients with systemic lupus erythematosus (SLE) may sometimes require admission to the intensive care unit (ICU), and the outcome is poor. The aim of this study was to explore the clinical features of patients with SLE in the ICU, identify prognostic factors, and develop and evaluate a prognostic model to predict in-ICU mortality of patients with SLE.Patients and Methods: This was a single center retrospective study in a tertiary medical institution in China. A total of 480 SLE patients with 505 ICU admissions from 2010 to 2019 were screened, and 391 patients were enrolled. The clinical feature and outcomes of the patients were analyzed. According to the random number table, patients were divided into two mutually exclusively groups named derivation (n = 293) and validation (n = 98). Prognostic factors were identified by a Cox model with Markov Chain Monte Carlo simulation and evaluated by latent analysis. The risk score was developed based on the derivation group and evaluated using the validation group.Results: Among the 391 patients, 348 (89.0%) patients were females. The median age of patients was 34 years, and the median course of SLE was 6 months. The median APACHE II and SLEDAI were 17 and 10, respectively. The average in-ICU mortality was 53.4% (95% CI, 48.5–58.4%). A total of 186 patients were admitted to the ICU due to infection. Pneumonia (320/391, 81.8%) was the most common clinical manifestation, followed by renal disease (246/391, 62.9%). Nine prognostic factors were identified. The model had C statistic of 0.912 (95% CI, 0.889–0.948) and 0.807 (95% CI 0.703–0.889), with predictive range of 5.2–98.3% and 6.3–94.7% for the derivation and validation groups, respectively. Based on distribution of the risk score, 25.3, 49.5, and 25.2% of patients were stratified into the high, average, and low-risk groups, with corresponding in-ICU mortality of 0.937, 0.593, and 0.118, respectively.Conclusion: Nine prognostic factors including age, white blood cell count, alanine transaminase, uric acid, intracranial infection, shock, intracranial hemorrhage, respiratory failure, and cyclosporin A/tacrolimus usage were identified. A prognostic model was developed and evaluated to predict in-ICU mortality of patients with SLE. These findings may help clinicians to prognostically stratify patients into different risk groups of in-ICU mortality, and provide patients with intensive and targeted management.

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“…Systemic lupus erythematosus(SLE) is an autoimmune disease,it can involve multiple organs throughout the body.Patients with systemic lupus erythematosus often need to be admitted to the intensive care unit because of infections, disease activity,and other reasons.The reported mortality rate was reached despite the availability of aggressive treatment 18.4%-78.5% [1] .In order to reduce the risk of death in patients with systemic lupus erythematosus admitted to the intensive care unit, several literatures have investigated the related risk factors.Aragón CCet al identi ed infection, invasive mechanical ventilation, vasoactive drug requirement, higher SOFA score, and antiphospholipid syndrome as risk factors for death [2] .However, Abramovich E et al found that systemic lupus erythematosus was not an independent risk factor for mortality in patients admitted to the intensive care unit with sepsis [3] .Although the risk factors for death are controversial.However, hypoalbuminemia is recognized by all an independent risk factor for poor prognosis [4,5] .…”

Section: Introductionmentioning

confidence: 99%

A Clinical Prediction Model to Predict albumin Treatment Outcomes and Provide Dosage Recommendations: Development and Validation Study

Li²

2023

Preprint

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Objective: Intravenous Albumin is widely used in the intensive care unit in patients with Systemic lupus erythematosus. However, The dose of albumin is still controversial.In this study, we intended to develop and validate a machine learning–based model to predict intravenous albumin treatment outcomes and to provide dosage recommendations to clinicians. Methods: Using Mimic-III V1.4 and Mimic-IV V0.4, we collected data from of patients with SLE admitted to the ICU. Data were divided into two groups based on death or survival within 30 days.Several machine learning methods were used to build prediction models, evaluating model performance by the model area under the receiver operating characteristic curve(AUC).The best performing prediction model was selected. Applying the model to make predictions. The value of intravenous albumin infusion in the input variable was changed using the actual albumin used by the clinician as the baseline. Find the dose that minimizes the risk of death. Results: Mimic-iv and Mimic-III was used to establish and validation the model. A total of 427 SLE patients, 109 of whom died. They were divided into two groups according to whether they died within 30 days. Random subspace method(RSM) integrated linear discriminant analysis model(LDA) were established. In the external validation AUC results of the models were 0.79[95% CI 0.78 0.82],the model performance was the best. Predictors were: Age at admission in years, Minimum WBC, Maximum WBC, Mechanical ventilation, Mean heart rate, Minimum systolic BP, Vasopressor, dialysis, Accompanied hypertension, nterstitial pneumonia associated with systemic lupus erythematosus, sofa, sirs, sapsii, apsiii, Intravenous administration of albumin, Immunoglobulin M, Minimum Albumin, Urine volume on the first day after admission to ICU, Infection, Complement C4.The model was used to calculate the recommended dose of albumin for intravenous infusion. In the MIMICIV database:366 patients in the survival group, 73 cases in the death group. The survival group improved 26 cases after applying our recommended dose, In the death group, 30 cases were improved. In the MIMICIII database:61 patients in the survival group,36 cases in the death group. The survival group improved 1 cases after applying our recommended dose, In the death group, 6 cases were improved. Conclusions: RSM-LDA model could be used in the clinical scenario of albumin was infused intravenously treatment with a dosage pattern. The results provide support for recommending optimal albumin was infused intravenously treatment dosing to clinicians.

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

Cited by 7 publications

References 32 publications

Outcome of critically ill patients with systemic lupus erythematosus from a medical intensive care unit in Southern India

Outcome of critically ill patients with systemic lupus erythematosus from a medical intensive care unit in Southern India

Development of a Novel Simple Model to Predict Mortality in Patients With Systemic Lupus Erythematosus Admitted to the Intensive Care Unit

A Clinical Prediction Model to Predict albumin Treatment Outcomes and Provide Dosage Recommendations: Development and Validation Study

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