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

Brünnler, T.; Susewind, Miriam; Hoffmann, Ute; Rockmann, Felix; Ehrenstein, Boris

doi:10.2169/internalmedicine.54.4283

Cited by 28 publications

(36 citation statements)

References 27 publications

(26 reference statements)

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“…Renal replacement therapy was frequently used for worsened liver failure and renal disease among comorbidities and was increased in the nonsurvivors of the 30-day mortality group. Together with the ndings from previous reports [12,54], our data indicate that ICU patients requiring renal replacement therapy showed poorer prognosis. Previous studies reported that other organ replacement therapies, including mechanical ventilation and vasopressors, were associated with a higher mortality in the ICU population [12,17,47,55,56].…”

Section: Discussionsupporting

confidence: 84%

“…Together with the ndings from previous reports [12,54], our data indicate that ICU patients requiring renal replacement therapy showed poorer prognosis. Previous studies reported that other organ replacement therapies, including mechanical ventilation and vasopressors, were associated with a higher mortality in the ICU population [12,17,47,55,56]. By contrast, the present study did not nd any difference in the 30-day mortality groups probably because our study only included RA patients and did not include those with other collagen diseases, such as systemic lupus erythematosus, dermatomyositis, Sjögren's disease, progressive systemic sclerosis, mixed connective tissue disease, or vasculitis.…”

Section: Discussionsupporting

confidence: 84%

“…In the current study, the majority of RA patients were treated with mechanical ventilation and vasopressor therapy after ICU admission. Similar to another study [12], there was a signi cantly greater use of renal replacement therapy in the nonsurvivors of the 30-day mortality group than in the survivors. Renal replacement therapy was frequently used for worsened liver failure and renal disease among comorbidities and was increased in the nonsurvivors of the 30-day mortality group.…”

Section: Discussionsupporting

confidence: 77%

“…Some studies have reported that the prognostic factors of ICU mortality in patients with RD included high APACHE II and SOFA scores, serious infection, mechanical ventilation, vasopressor, renal replacement therapy, and glucocorticoid dose [6,7,9,11,12,17,28]. The APACHE II and SOFA scores, which were predictive factors of ICU mortality in the general population, have also predicted ICU mortality in RA patients [6,7,11,12,14,23]. In line with previous studies [11,[57][58][59], our multivariate analysis also identi ed an elevated APACHE II score as a predictor of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study reported that the reasons for the ICU admission of RA patients included CVD and serious infection and showed that RA patients have increased one-year mortality compared with the general population [8]. The prognostic factors for mortality in RA patients admitted to the ICU included admission for infection, higher acute physiology and chronic health evaluation (APACHE) II score [10], and necessity for mechanical ventilation or renal replacement therapy [6][7][8][9][11][12][13][14]. Furthermore, the risk factors for the admission of RA patients to an ICU included older age and comorbidities such as chronic obstructive pulmonary disorder (COPD) classifying or weighting comorbid conditions according to the updated Charlson's comorbidity index (CCI) [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Fujiwara

Tokuda

Momii

et al. 2020

Preprint

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Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Fujiwara

Tokuda

Momii

et al. 2020

Preprint

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Patients with systemic rheumatic diseases admitted to the intensive care unit: what the rheumatologist needs to know

2018

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Patients with systemic rheumatic diseases (SRDs) may require admission to the intensive care unit (ICU) throughout the course of their disease. Therefore, the rheumatologist needs an understanding of the factors which may influence the course of patients with SRDs who are admitted to ICU. These include the causes for admission, patient characteristics including comorbidities and drug therapies, outcome (in-ICU mortality and causes of death), and prognostic factors. Infections and exacerbation/complications of SRDs are the most common (and potentially reversible) reasons for both admission and death on ICU. Mortality in patients with SRDs admitted to ICU has been reported to be either no different or higher than 'general' ICU patients. Reported prognostic factors included patient and disease characteristics, as well as ICU factors, including scoring systems. Rheumatologists need to be aware of the factors surrounding admission of patients with SRDs to ICU, including the need for strong links with critical care medicine.

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RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis

et al. 2017

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Rheumatoid arthritis (RA) patients are at increased risk of infection. Aim of the present study was to investigate whether RA patients admitted to an intensive care unit (ICU) due to infection have higher Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk scores compared to control RA patients. Seventy-four RA patients (32.4% male) admitted to an ICU due to infection (from January 2002 to December 2013) and 74 frequency-matched control RA patients (16.2% male) were included in this cross-sectional study. There was strong evidence for a higher RABBIT risk score in ICU patients (median 2.0; IQR 1.3-3.2) as compared to controls (1.3; IQR 0.8-2.0; p < 0.0001). Traditional disease-modifying anti-rheumatic drugs (DMARDs) (82.4 vs 64.9%; p = 0.015) and biological DMARDs (28.4 vs 14.9%; p = 0.012) were more frequently given to RA patients without ICU admission. Glucocorticoid users were more frequently found in the ICU group (51.4 vs 31.1%; p = 0.012). In a multivariable analysis tDMARD use was associated with lower (OR 0.38; 95% CI 0.15-0.93; p = 0.034) and glucocorticoid use with borderline higher odds of ICU admission (OR 2.05; 95% CI 0.92-4.58; p = 0.078). Chronic obstructive pulmonary disease (OR 2.89; 95% CI 1.10-7.54; p = 0.03), chronic kidney disease (OR 16.08; 95% CI 2.00-129.48; p = 0.009), and age category (OR 2.67; 95% CI 1.46-4.87; p = 0.001) were strongly associated with ICU admission. There was a strong trend towards higher odds of ICU admission with increasing RABBIT risk score. Use of tDMARDs was associated with lower odds of ICU admission. In an adjusted analysis, bDMARDs were not associated with ICU admission. COPD, CKD, and age were strong risk factors for ICU admission.

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

Cited by 28 publications

References 27 publications

Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Patients with systemic rheumatic diseases admitted to the intensive care unit: what the rheumatologist needs to know

RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis

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