Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study

Abstract

PurposeData for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce.MethodsWe included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002–2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group.Results In the ICU group, patients predominantly showed granulomatosis with polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU group showed comparable Birmingham vasculitis activity score and a higher frequency of heart, central nervous system and lungs involvements. Respiratory assistance, renal replacement therapy and vasopressors were required in 68.0, 56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) patients died during the ICU stay. The following were significantly associated with ICU mortality in the univariate analysis: the need for respiratory assistance, the use of vasopressors, the occurrence of at least one infection event in ICU, cyclophosphamide treatment, sequential organ failure assessment at admission and simplified acute physiology score II. After adjustment on sequential organ failure assessment or infection, cyclophosphamide was no longer a risk factor for mortality. Despite a higher initial mortality rate of ICU patients within the first hospital stay (p < 0.0001), the long-term mortality of hospital survivors did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively, p = 0.36). Moreover, we observed no renal survival difference between groups after a 1-year follow-up (82.1 and 80.5%, p = 0.94).ConclusionThis study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0262-9) 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.…”

“…Previous studies have found highly heterogeneous results related to ICU mortality of AAV patients. 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].…”

“…The following scores were also obtained from the patients 24 h after ICU admission; Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, Simplified Acute Physiology Score (SAPS) II. Patients diagnosed with AAV within the last 30 days before ICU admission or during ICU stay were considered as newly diagnosed patients [10]. On the other hand, the case of patients who had more than 30 days between AAV diagnosis and ICU admission and were admitted to ICU with new vasculitis involvement was considered as a relapse.…”

“…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].…”