Mortality of patients with systemic lupus erythematosus admitted to the intensive care unit – A retrospective single-center study

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

doi:10.1016/j.berh.2019.01.013

Cited by 16 publications

(21 citation statements)

References 30 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%

“…Approximately a quarter of patients with SLE are hospitalized each year because of associated medical comorbidities, infection and side effects of immunosuppressive therapies. 10–13 SLE has become the leading autoimmune disease necessitating admission to the intensive unit care (ICU); 14–17 the demand rate for critical services among patients with SLE is around 13.8%. 18…”

Section: Introductionmentioning

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%

Section: Introductionmentioning

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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“…Although there have been a number of survival studies of SLE in the past decade, not too many were performed in the Asian populations (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Analysis of the survival of hospitalized patients (9,22), those admitted to the intensive care unit (12,19) or referred to tertiary centers (23), subsets of patients with nephritis (14), neuropsychiatric manifestations (17), or pulmonary hypertension (15) in some studies would create bias in the mortality rate. Moreover, the follow-up of most of these Asian studies was not long enough to look at the trend of survival over time.…”

Section: Introductionmentioning

confidence: 99%

Trend of Survival of a Cohort of Chinese Patients With Systemic Lupus Erythematosus Over 25 Years

Mok

Chan

et al. 2020

Front. Med.

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Objectives: To revisit the trend of survival of systemic lupus erythematosus in a cohort of Chinese patients over 25 years. Methods: Patients who fulfilled the 1997 ACR criteria for SLE and were followed in our hospital since 1995 were included. Patients were stratified into two groups according to the year of diagnosis: (1) 1995-2004 and (2) 2005-2018. Survival of patients was studied by Kaplan-Meier analysis. Organ damage as assessed by the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) and causes of death in the first 10 years of SLE onset was compared between the two groups. Cox regression was used to study factors associated with survival. Results: A total of 1,098 SLE patients were registered in our database. After excluding 157 patients diagnosed outside the time period of 1995-2018, 941 patients were studied (92% women). All were ethnic Chinese. The mean age of SLE onset was 35.1 ± 14.4 years, and the mean duration of observation was 13.1 ± 6.6 years. Seventy-seven (8.2%) patients were lost to follow-up. Groups 1 and 2 consisted of 364 and 577 patients, respectively. The mean SDI score at 10 years of disease onset was significantly higher in group 1 than group 2 patients (1.01 ± 1.43 vs. 0.57 ± 0.94; p < 0.01), particularly in the neuropsychiatric, musculoskeletal, and gonadal domains. Within 10 years of SLE onset, 32 (8.8%) patients in group 1 and 25 (4.3%) patients in group 2 died (p = 0.005). The 5-and 10-year cumulative survival rates were 93.6 and 91.0% in group 1 and 96.5 and 94.2% in group 2 patients, respectively (log-rank test p = 0.048). Infection accounted for more than half of the deaths in both groups. More group 1 than group 2 patients died of vascular events, but the difference was not statistically significant. Cox regression showed that the age of SLE onset and damage score accrued at 10 years, but not the time period in which SLE was diagnosed, were significantly associated with mortality. Conclusions: The improvement in survival of our SLE patients is probably related to the accrual of less organ damage in the past 15 years.

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“…In contrast, Zamir et al. 32 reported that an APACHE II score >27 was useful in predicting mortality. Despite these inconsistencies, to date, the APACHE II score is the most common variable associated with mortality.…”

Section: Discussionmentioning

confidence: 91%

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

Aragón

Ruiz-Ordóñez

Quintana

et al. 2020

Lupus

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Objective Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and in some conditions, admission to the intensive care unit (ICUs) is required. This study describes the clinical and prognostic factors in SLE patients admitted to the ICU. Methods We conducted a retrospective study that reviewed all clinical records of patients with SLE admitted to the ICU between 2011 and 2018. Results We evaluated 188 patients, with 279 ICU admissions. Most patients were female ( n = 159; 84.57%) with a median age of 35 years (interquartile range (IQR) = 25–48 years). Infection was the leading cause of admission in 77 (27.60%) cases, followed by lupus flare. The average length of hospitalization was 5 days (IQR 3–11 days), and the SLE Disease Activity Index 2000, Acute Physiology, Age and Chronic Health Evaluation (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores were 9 (IQR 2–17), 14 (IQR 10–17), and 3 (IQR 2–5), respectively. Non-survivors presented with higher APACHE II and SOFA scores. Infection was the leading cause of mortality ( n = 38; 20.21%), and predictors of mortality included invasive mechanical ventilation, vasoactive medication requirement, higher SOFA scores, and antiphospholipid syndrome comorbidity. Conclusions We found that infection was the leading cause of ICU admissions and mortality in patients with SLE. Factors identified here as predictors of mortality should be accurately identified at admission for the prompt treatment of SLE patients.

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Mortality of patients with systemic lupus erythematosus admitted to the intensive care unit – A retrospective single-center study

Cited by 16 publications

References 30 publications

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

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

Trend of Survival of a Cohort of Chinese Patients With Systemic Lupus Erythematosus Over 25 Years

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

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