Prognosis and ICU outcome of systemic vasculitis

Abstract

BackgroundSystemic vasculitis may cause life threatening complications requiring admission to an intensive care unit (ICU). The aim of this study was to evaluate outcomes of systemic vasculitis patients admitted to the ICU and to identify prognosis factors.MethodsDuring a ten-year period, records of 31 adult patients with systemic vasculitis admitted to ICUs (median age: 63 y.o, sex ratio M/F: 21/10, SAPS II: 40) were reviewed including clinical and biological parameters, use of mechanical ventilation, catecholamine or/and dialysis support. Mortality was assessed and data were analyzed to identify predictive factors of outcome.ResultsCauses of ICU admissions were active manifestation of vasculitis (n = 19), septic shock (n = 8) and miscellaneous (n = 4). Sixteen patients (52%) died in ICU. By univariate analysis, mortality was associated with higher SOFA (p = 0.006) and SAPS II (p = 0.004) scores. The need for a catecholamine support or/and a renal replacement therapy, and the occurrence of an ARDS significantly worsen the prognosis. By multivariate analysis, only SAPS II (Odd ratio: 1.16, 95% CI [1.01; 1.33]) and BVAS scores (Odd ratio: 1.16, 95% CI = [1.01; 1.34]) were predictive of mortality.ConclusionThe mortality rate of severe vasculitis requiring an admission to ICU was high. High levels of SAPS II and BVAS scores at admission were predictive of mortality.

The prognostic significance of the Birmingham Vasculitis Activity Score (BVAS) with systemic vasculitis patients transferred to the intensive care unit (ICU)

“…These diseases may often cause life-threatening complications requiring admission to ICU [13,14] depending on several factors: the exposure to external agents, mostly infections, the therapy, which usually results in immunosuppression, and the comorbidities of the patient. [13,15] …”

“…In ICU, 52% of patients died and BVAS score and Simplified Acute Physiology Score (SAPS) II were the parameters predicting mortality in a multivariate analysis. [14] …”

“…[1] In contrast, the latest data demonstrated that BVAS score is independently related to the mortality in ICU. [14] Starting from these reports, we stratified our patients according to the value of the BVAS at the admission to the ward and to ICU. Therefore, we have also performed the APACHE II score in our study.…”

A retrospective study on the outcomes of MPO-ANCA-associated vasculitis in dialysis-dependent patients

“…BVAS is a universal standard to evaluate vasculitic activity, but its value as a predictor of mortality or relapse is controversial [18][19][20]. As for CY use, indications are different between Japanese guidelines [17] and British Society for Rheumatology (BSR)/British Health Professionals in Rheumatology (BHPR) guidelines [21].…”

Diagnostic and Treatment of Cryoglobulinemiс Vasculitis: What is Important for Real Clinical Practice?

“…Эти желудочно-кишечные проявления обусловлены дистальным васкулитом, поражающим брыжеечные артериолы и капилляры. Кроме того, у пациентов с хронической ВГС-инфекцией и криоглобулинемией частота развития цирроза и показатели фиброза печени выше, чем у пациентов без криоглобулинемии [3]. Рис.…”