Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study

Haviv-Yadid, Yael; Segal, Yulia; Dagan, Amir; Sharif, Κassem; Bragazzi, Nicola Luigi; Watad, Abdulla; Amital, Howard; Shoenfeld, Yehuda; Shovman, Ora

doi:10.1007/s10067-019-04651-w

Cited by 10 publications

(20 citation statements)

References 23 publications

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“…In fact, in our study including only patients with RA, the 30-day mortality of the nonsurvivors was signi cantly higher than that of the survivors (21.7 ± 9.2 vs 14.6 ± 5.6). So far, only one report [17] has investigated the APACHE II score speci cally in patients with RA, and our study demonstrated that the association between APACHE II score and mortality of RA is similar to that in previous reports on RD. Considering that the APACHE II scores of RD patients were shown to be approximately equal to those of the general population due to their critical condition needed intensive care [14,17], the results of the current study show that the APACHE II score in RA patients was also a prognostic factor of ICU mortality.…”

Section: Discussionsupporting

confidence: 88%

“…So far, only one report [17] has investigated the APACHE II score speci cally in patients with RA, and our study demonstrated that the association between APACHE II score and mortality of RA is similar to that in previous reports on RD. Considering that the APACHE II scores of RD patients were shown to be approximately equal to those of the general population due to their critical condition needed intensive care [14,17], the results of the current study show that the APACHE II score in RA patients was also a prognostic factor of ICU mortality. Finally, laboratory tests showed that coagulation abnormalities were a prognostic biomarker associated with poor outcome in all ICU mortality [60].…”

Section: Discussionsupporting

confidence: 88%

“…Together with the ndings from previous reports [12,54], our data indicate that ICU patients requiring renal replacement therapy showed poorer prognosis. Previous studies reported that other organ replacement therapies, including mechanical ventilation and vasopressors, were associated with a higher mortality in the ICU population [12,17,47,55,56]. By contrast, the present study did not nd any difference in the 30-day mortality groups probably because our study only included RA patients and did not include those with other collagen diseases, such as systemic lupus erythematosus, dermatomyositis, Sjögren's disease, progressive systemic sclerosis, mixed connective tissue disease, or vasculitis.…”

Section: Discussioncontrasting

confidence: 72%

“…Previous studies have examined the risk factors and mortality of RA patients after ICU treatment [6-9, 11-15, 17, 27, 28]. The short-term fatal outcome of RD, including RA, tended to be worse in RA patients than in the general population [9,17,27], and the long-term (1-3 years) mortality of RA patients was signi cantly increased after ICU admission [8,27]. In our institution, the 30-day, 90-day, and 1-year mortalities after ICU admission were 21%, 27%, and 37%, each.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, despite the lack of a signi cant difference in dose-related risk of glucocorticoids in the multivariate analysis, a higher glucocorticoid dose appeared to be associated with an increased risk of mortality. Based on previous reports on the risks related to infections and medications, including glucocorticoid, csDMARDs, and bDMARDs [6,15,17,36,39,40] [35,41], a dose-related glucocorticoid was reported to increase the risk of infection, whereas csDMARDs were reported to reduce the risk and mortality in RA [42] [15,43]. Treatment with glucocorticoids raised the incidence and hazard of adverse effects in RA patients, such as diabetes mellitus, osteoporosis, thrombotic stroke, CVD, serious infection, and death [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Fujiwara

Tokuda

Momii

et al. 2020

Preprint

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Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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Section: Discussionsupporting

confidence: 88%