Outcome of patients with systemic lupus erythematosus in intensive care unit

Abstract

The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.

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

“…However, there are conflicting results regarding the significance of this scoring tool with respect to the outcomes of ICU patients. Although previous studies have demonstrated that the Apache II score is a suitable predictor of the outcomes in patients admitted to the ICU (9,11,13,14,17,24,25), this observation has not been confirmed in other studies (3,26); the latter studies reported that the Apache II score is not independently, or only weakly, associated with mortality. Therefore, we performed a careful analysis of the Apache II score, which subsequently demonstrated a strong correlation between an increased Apache II score and a poor outcome in our cohort, supporting the use of this tool in patients with rheumatic diseases admitted to the ICU.…”

Predicting outcome and survival in patients with Wegener's granulomatosis treated on the intensive care unit

“…In the literature, reports on rheumatic diseases are available, for example on systemic lupus erythematosus, dermato-polymyositis, rheumatoid arthritis, and vasculitis (16)(17)(18)(19)(20)(21)(22). However, data on these diseases cannot be applied to patients with WG, as it is a very different disease.…”

“…It could be that with earlier diagnosis and earlier adequate immunosuppressive therapy, stabilization of the disease might have been possible, and ICU admission might not have been necessary. The situation with WG patients differs from patients with other rheumatic diseases, who sometimes need ICU treatment several years after the diagnosis was made, mainly due to infections after long periods of immunosuppressive therapy (16)(17)(18)(19)(20)(21)(22).…”

“…The findings for other symptoms such as pulmonary infection, ear, nose, and throat infection, haemoglobin, leucocyte and thrombocyte count, and serum albumin concentration differ widely in various studies (7)(8)(9)(10)(11)(12)(13)(14)(15). Patients with WG must have been frequently treated in an intensive care unit (ICU), but in the literature only reports of ICU treatment of patients with rheumatic diseases (16)(17)(18)(19)(20)(21)(22) or necrotizing vasculitis (23) are available. WG patients had sometimes been included but compared with other diseases; WG had been under-represented or was not clearly separated.…”

Infections and Systemic Lupus Erythematosus

“…It has been shown that not infected patients with SLE admitted to the ICU with lupus flares, exhibit high mortality rates (75-95%), and nosocomial acquired infections are a relevant complication in most cases. These reports, as well as others (Alzeer et al, 2004), highlight the importance of pneumonia and bacterial sepsis of unknown origin as the most frequent reason for admission to ICU, and their relationship with poor outcomes.…”