Patients With Vasculitides Admitted to the Intensive Care Unit: Implications From a Single-Center Retrospective Study

Haviv, Yael; Shovman, Ora; Bragazzi, Nicola Luigi; Sharif, Κassem; Yavne, Yarden; Shoenfeld, Yehuda; Amital, Howard; Watad, Abdulla

doi:10.1177/0885066617717223

Cited by 11 publications

(18 citation statements)

References 18 publications

(36 reference statements)

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“…The fact that all MSSA and MRSA cultures in our cohort were obtained from GPA patients emphasizes the likely involvement of Staphylococcus aureus in the pathogenesis of GPA. 32,33 Rituximab (RTX) was not associated with increased mortality in our cohort, which is contrary to the results of Haviv et al 4 Since the number of patients under RTX is low (n ¼ 4 in both studies), the finding of a significant association by Haviv et al is difficult to interpret.…”

Section: Discussioncontrasting

confidence: 99%

“…4,7,8,10 However, the predictive power of this score was higher in our cohort compared to the result of Haviv et al (AUC 0.898 vs. 0.761). 4 In contrast to our study, Haviv et al investigated any vasculitis ICU admissions, and both glucocorticoid use as well as RRT were more prevalent among their patients, probably reflecting severely ill patients with a higher mortality. Surprisingly, this assumption is not supported by either SOFA or APACHE II score, which were both lower than in our cohort.…”

Section: Discussioncontrasting

confidence: 93%

“…28 A literature search on mortality of vasculitis patients under intensive care only brought up studies on ICU treatment in general. [4][5][6][7][8]10,[21][22][23][24] Investigations on ICU treatment for sepsis in particular are missing. We have found differing results while comparing our mortality to that in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…10,13,14 The predominant infection site are the lungs. 4,7,10,[12][13][14] Remarkably, despite (inter-)national recommendations, 15,16 vaccination rates for preventable pathogens (e.g. Streptococcus pneumoniae, Influenza) are low among patients with inflammatory rheumatic diseases and immunosuppression in general.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19] Contrary to patients with Rheumatoid Arthritis, 20 investigations on vasculitis and intensive care treatment for sepsis are scarce or address ICU treatment in general without focusing on sepsis in particular. [4][5][6][7][8]10,[21][22][23][24] We therefore planned to investigate retrospectively the outcome of sepsis in necrotizing vasculitis patients requiring intensive care treatment in a university hospital in Germany.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

Krasselt

Baerwald

Petros

et al. 2020

J Intensive Care Med

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Introduction/Background: Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. Methods: The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. Results: The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). Conclusions: Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

Krasselt

Baerwald

Petros

et al. 2020

J Intensive Care Med

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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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Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study

et al. 2019

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Patients With Vasculitides Admitted to the Intensive Care Unit: Implications From a Single-Center Retrospective Study

Abstract: Our study confirms the high mortality rate among patients with vasculitides who require ICU care as well as the roles of infection and disease flare-up as causes for admission. An elevated SOFA score was found to be predictive of mortality.

Cited by 11 publications

References 18 publications

Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

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

Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study

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