Outcome of patients having dermatomyositis admitted to the intensive care unit

Abstract

Patients having systemic rheumatic diseases constitute a small percentage of admissions to the medical intensive care units (ICUs). Dermatomyositis (DM) is one of the rheumatic diseases that have secondary complications that may lead to a critical illness requiring hospitalization in the ICU. Herein, we present the features, clinical course, and outcome of critically ill patients having DM who were admitted to the ICU. The medical records of six DM patients admitted to the ICU in a large tertiary hospital in a 12-year period were reviewed. The mean age of patients at time of admission to the ICU was 38 (range 16-37). Mean disease duration from diagnosis to admission to the ICU was 1.6 years (range 1 month-8 years), while the main reason for admission to the ICU was acute respiratory failure. Two of six patients died during the hospitalization. The main causes of death were respiratory complications and sepsis. The outcome of DM patients admitted to the ICU was generally not different from the outcome of other patients hospitalized in the ICU. The main reason for hospitalization was acute respiratory failure. As there are many reasons for respiratory failure in DM, an early diagnosis and aggressive appropriate treatment may help to further reduce the mortality in these patients.

Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases

“…In a previous study of 6 ICU patients with dermatomyositis, in-hospital mortality was 33% [26], similar to the 30-day mortality rate in the dermatomyositis patients in our study. The poor prognosis of dermatomyositis may be related to the poor response of dermatomyositis-associated interstitial pneumonitis to immunosuppressive drugs and/or to the high rate of cancer among patients with dermatomyositis (2 of 9 patients in our study).…”

Outcomes and Prognostic Factors in Patients with Rheumatologic Diseases Admitted to the ICU

“…Compared to that observed in other studies, our findings showed better outcomes, with an ICU mortality rate of 16% and a hospital mortality rate of 20%, which may reflect the effects of recent advances in ICU management and rheumatologic care (3,(9)(10)(11)13). In addition, the median Apache II score was 12 among the admitted patients, which is lower than that noted in previous observa- ions (2,5,12). The present results demonstrated a substantial impact of treatment for the underlying rheumatic disease prior to ICU admission on the outcomes of the patients.…”

Invasive ductal breast cancer associated polymyositis causing respiratory failure

“…Respiratory muscle weakness and hypercapnea should be treated by mechanical ventilation and corticosteroids. When treatment with corticosteroids fails, the patient should be treated with agents such as methotrexate, azathioprine, cyclophosphamide, intravenous immune globulin, cyclosporine, tacrolimus, alkylating agents, and tumor necrosis factor inhibitors [19,21].…”