One-Year Outcome of Critically Ill Patients With Systemic Rheumatic Disease

Abstract

BACKGROUND: Critically ill patients with systemic rheumatic disease (SRD) have benefited from better provision of rheumatic and critical care in recent years. Recent comprehensive data regarding in-hospital mortality rates and, most importantly, long-term outcomes are scarce.RESEARCH QUESTION: The aim of this study was to assess short and long-term outcome of patients with SRD who were admitted to the ICU.STUDY DESIGN AND METHODS: All records of patients with SRD who were admitted to ICU between 2006 and 2016 were reviewed. In-hospital and one-year mortality rates were assessed, and predictive factors of death were identified.RESULTS: A total of 525 patients with SRD were included. Causes of admission were most frequently shock (40.8%) and acute respiratory failure (31.8%). Main diagnoses were infection (39%) and SRD flare-up (35%). In-hospital and one-year mortality rates were 30.5% and 37.7%, respectively. Predictive factors that were associated with in-hospital and one-year mortalities were, respectively, age, prior corticosteroid therapy, simplified acute physiology score II $50, need for invasive mechanical ventilation, or need for renal replacement therapy. Knaus scale C or D and prior conventional disease modifying antirheumatic drug therapy was associated independently with death one-year after ICU admission.INTERPRETATION: Critically ill patients with SRD had a fair outcome after an ICU stay. Increased age, prior corticosteroid therapy, and severity of critical illness were associated significantly with short-and long-term mortality rates. The one-year mortality rate was also associated with prior health status and conventional disease modifying antirheumatic drug therapy.

Outcomes of Severe Systemic Rheumatic Disease Patients Requiring Extracorporeal Membrane Oxygenation

“…This inverse proportion reflects bias related to the population for which ECMO is indicated: a small percentage of bacterial/viral pneumonias require VV-ECMO implantation and few infections (mainly severe septic shock) will need VA-ECMO cannulation. At the same time, the number of patients admitted for their first SRD manifestation was particularly high: one-third of our patients vs. onetenth in previous reports [2,3]. While those admissions for infection had usually been associated with worse outcomes, the in-hospital survival rates of our flare and infection patients were similar.…”

“…Available literature is scarce, other than multiple case reports, and ECMO use was anecdotical in previous populations: 6 (1.6%) patients in the study by Dumas and colleagues [2], 6 (7.3%) and 3 (3.1%) in the largest ICU studies on antineutrophil cytoplasm antibody-associated vasculitides [15,16]. A significant number of the 62 (11.8%) ECMO-treated patients in Larcher and colleagues' recent paper [3] were managed in our center and are also included herein, however this study did not specifically addressed the characteristics, management and outcomes of ECMO-treated patients and, therefore, does not duplicate the results of the present study.…”

“…Indeed, the main series of critically ill SRD patients reported 16-21% in-ICU [2,4] and 20-43% in-hospital-mortality rates [1,3,[17][18][19][20][21]. However, our patients were obviously more severely ill, as shown by their higher median day-0 SOFA scores and day-0 SAPS II, respectively: 13.5 vs. 5-7.2 [2,3,19] and 59 vs. 29-45 [3,4,21]. Moreover, our in-hospital-mortality rate was similar to those of ESLO patients: ~ 43% VV-ECMO-treated [12] and ~ 58% VA-ECMO-treated [11].…”

“…2 Service de Chirurgie Cardiothoracique, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHP, Paris, France. 3 Service de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de L'Hôpital, 75651 Paris Cedex 13, France. 4 Centre de Référence National Lupus Systémique, Syndrome Des Anticorps Anti-Phospholipides Et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France.…”

“…They share common characteristics: multiorgan Open Access *Correspondence: marc.dechambrun@gmail.com 1 Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France Full list of author information is available at the end of the article involvement responsible for end-organ failures; specific treatments causing immunosuppression and infectious complications; and are rare entities with challenging diagnoses and diagnostic difficulties. Outcomes of SRD patients requiring ICU admission remain unclear, with 16%-33% reported in-ICU mortality [1][2][3][4].…”