Outcomes of patients admitted to intensive care units for acute manifestation of small-vessel vasculitis: a multicenter, retrospective study

Abstract

BackgroundThe outcomes of patients admitted to the intensive care unit (ICU) for acute manifestation of small-vessel vasculitis are poorly reported. The aim of the present study was to determine the mortality rate and prognostic factors of patients admitted to the ICU for acute small-vessel vasculitis.MethodsThis retrospective, multicenter study was conducted from January 2001 to December 2014 in 20 ICUs in France. Patients were identified from computerized registers of each hospital using the International Classification of Diseases, Ninth Revision (ICD-9). Inclusion criteria were (1) known or highly suspected granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis (respectively, ICD-9 codes M31.3, M30.1, and M31.7), or anti–glomerular basement membrane antibody disease (ICD-9 codes N08.5X-005 or M31.0+); (2) admission to the ICU for the management of an acute manifestation of vasculitis; and (3) administration of a cyclophosphamide pulse in the ICU or within 48 h before admission to the ICU. The primary endpoint was assessment of mortality rate 90 days after admission to the ICU.ResultsEighty-two patients at 20 centers were included, 94 % of whom had a recent (<6 months) diagnosis of small-vessel vasculitis. Forty-four patients (54 %) had granulomatosis with polyangiitis. The main reasons for admission were respiratory failure (34 %) and pulmonary-renal syndrome (33 %). Mechanical ventilation was required in 51 % of patients, catecholamines in 31 %, and renal replacement therapy in 71 %. Overall mortality at 90 days was 18 % and the mortality in ICU was 16 %. The main causes of death in the ICU were disease flare in 69 % and infection in 31 %. In univariable analysis, relevant factors associated with death in nonsurvivors compared with survivors were Simplified Acute Physiology Score II (median [interquartile range] 51 [38–82] vs. 36 [27–42], p = 0.005), age (67 years [62–74] vs. 58 years [40–68], p < 0.003), Sequential Organ Failure Assessment score on the day of cyclophosphamide administration (11 [6–12] vs. 6 [3–7], p = 0.0004), and delayed administration of cyclophosphamide (5 days [3–14] vs. 2 days [1–5], p = 0.0053).ConclusionsPatients admitted to the ICU for management of acute small-vessel vasculitis benefit from early, aggressive intensive care treatment, associated with an 18 % death rate at 90 days.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1189-5) contains supplementary material, which is available to authorized users.

Value of prognostic scores in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey

“…BVAS (neither BVAS on the first ICU day nor BVAS at vasculitis diagnosis) was not associated with ICU mortality in our study. This finding is supported by other studies investigating ICU mortality of AAV patients [4,[10][11][12][13]. It is known, however, that BVAS was designed to assess vasculitic patients prospectively, and the retrospective analysis might have underestimated the score.…”

“…In the study of Frausova et al [4], there was a statistically significant difference in the APACHE II score for ICU mortality. Also, in the studies of Demiselle et al [10] and Kimmoun et al [13], there were statistically ROC-Curve analysis of APACHE II score for ICU mortality (AUC= 0.8, P = 0.004). The cutoff value of APACHE II score = 20.5 (80% sensitivity, 70% specificity, LR = 2.6) significant differences for SAPS II scores according to ICU mortality.…”

“…For example, Demiselle et al reported that the mortality rate of AAV patients with acute vasculitis manifestation was 15.5% [10]. In a similar study that included the patients of small vessel vasculitis, the mortality rate was found 16% in the ICU follow up period [13]. In other studies, the ICU mortality of the AAV patients was found as 33, 39, and 60%, respectively [4,12,18].…”

“…The latest version of the BVAS (version 3) was also validated for ANCA related vasculitis [8,9]. To our knowledge, there is a limited number of studies in the literature investigating the clinical and ICU outcomes of patients with AAV [4,[10][11][12][13]. In fact, these patients constitute only a small part of the patients who are admitted to the ICU [5].…”

Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies

“…Early diagnosis of intracranial vasculopathies, including intracranial atherosclerotic disease (ICAD), reversible cerebral vasoconstriction syndrome (RCVS) and infectious/inflammatory vasculopathies (IVas) is important, as inappropriate or delayed therapy can lead to worse outcomes 1–3 . Current diagnostic imaging algorithms rely on luminal imaging for disease differentiation, with catheter angiography (DSA) serving as the imaging gold standard 4 .…”