Outcome of patients with connective tissue disease requiring intensive care for respiratory failure

Abstract

Occasionally acute respiratory failure (ARF) develops in patients with connective tissue disease (CTD), but the etiologies of ARF in these patients are not fully elucidated. The objective of this study is to find out the causes of ARF leading to intensive care unit (ICU) admission in these patients and to assess their clinical outcome. The medical records of 1,870 consecutive patients admitted to the ICU in Seoul National University Hospital since January 2005-September 2008 were reviewed. A total of 66 patients with CTD were analyzed. The median age was 58 years, and 45 patients were women. The median length of ICU stay was 16 days with a median duration of mechanical ventilation support of 15 days. The distribution of underlying CTD was 17 patients with systemic lupus erythematosus; 15 with rheumatoid arthritis; 14 with systemic vasculitis; and nine with polymyositis-dermatomyositis. Pneumonia was the leading cause of ARF in 24 patients (36%). We could not identify the cause of ARF in 14. Other causes of ARF were acute pulmonary edema for nine patients, diffuse alveolar hemorrhage for eight and Pneumocystis pneumonia for four. Forty-one patients (62%) died during admission, and the mortality rate was the lowest in those with acute pulmonary edema. Use of norepinephrine was statistically higher in nonsurvivors. We could identify the cause of ARF leading to ICU admission in at least 80% of patients with CTD. However, these patients still showed a high mortality rate regardless of etiology. Their survival might be influenced by hemodynamic status.

Etiologies and Outcomes of Rheumatology Patients with Acute Respiratory Failure Requiring Intensive Care: A Single-Center Cohort Study of 259 Patients

“…The mortality rate of our patients was comparable to that in a Korean study, which reported a mortality rate of 62% among 66 patients with CTD requiring ICU admission for respiratory failure [7]. It had been reported that the mortality from lung diseases in patients with SRDs, such as RA was about twice as that of the general population [20][21][22].…”

“…Despite different immunological mechanisms and clinical manifestations, rheumatology patients are often characterized by chronic inflammation, multiorgan involvement, and acute exacerbation (flareup) [1,2]. Among all hospitalized rheumatology patients, up to one third need admission to intensive care unit (ICU) [1] while mortality rates are highly variable (from 16-80%), depending on underlying systemic rheumatic diseases (SRDs), reasons of ICU admission, severity of acute illness, and organ involvement/dysfunction [3][4][5][6][7][8][9][10][11][12].…”

“…Both multicenter [3] and single-center [4][5][6][7][8][9][10][11][12] studies have been performed among rheumatology patients admitted to the ICU during the past two decades, reporting characteristics and clinical outcome in patients with all forms [3][4][5][6][7][8][9][10] or a specific form of SRDs [11,12]. However, only one study focused on rheumatology patients admitted to ICU due to ARF [7]. In addition, although some studies have identified important prognostic factors in multivariate regression analysis, most did not include laboratory tests [3,5,7,8,11], such as CD4 + T-lymphocyte or lymphocyte count, which is an independent risk factor for mortality [12].…”

“…However, only one study focused on rheumatology patients admitted to ICU due to ARF [7]. In addition, although some studies have identified important prognostic factors in multivariate regression analysis, most did not include laboratory tests [3,5,7,8,11], such as CD4 + T-lymphocyte or lymphocyte count, which is an independent risk factor for mortality [12].…”

Ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease: is it safe?

“…In this case we suspect that increased serum estradiol levels coupled with oocyte retrieval under sedation may have exacerbated esophageal reflux causing aspiration pneumonia [8]. Infection subsequently precipitated respiratory failure and a cascade of multi-organ system dysfunction, typical of patients with severe rheumatologic disorders [9]. There are limited data on the safety of ovarian stimulation and oocyte retrieval in patients with MCTD.…”