Prognosis and outcome of 26 patients with systemic necrotizing vasculitis admitted to the intensive care unit

Abstract

The main reason for admitting SNV patients to the ICU was active vasculitis, which was often the first manifestation of SNV and led to its diagnosis. ICU disease severity scores at admission were associated with mortality in the ICU but did not predict long-term outcome, unlike BVAS, which accurately predicted long-term outcome but not ICU prognosis for patients admitted to the ICU with active SNV.

Outcome of Thirty Patients with ANCA-Associated Renal Vasculitis Admitted to the Intensive Care Unit

“…Similar to previous studies, [7,13] the most common reason for ICU admission in our study was active vasculitis (43.3%), with pulmo-renal syndrome including alveolar hemorrhage observed in most patients (36.7%). As the diagnosis was newly established in ICU in 12 patients (40%), AAV should always be considered in the differential diagnosis of patients admitted to the ICU due to severe pulmonary and/or renal manifestations of yet unknown origin.…”

“…[14] In recent retrospective studies, the reported mortality rates were usually lower-23% for patients with rheumatic diseases [15] ; 15% and 11%, respectively, for patients with vasculitis. [7,13] In our study, the overall in-ICU mortality rate was slightly higher (33%) than in the previously mentioned studies. [7,13] However, the predicted mortality (based on APACHE II score) in our group of patients was higher than that reported by Cruz et al [13] for both non-survivors (71% vs. 51%) and survivors (40% vs. 22%).…”

“…[7,13] In our study, the overall in-ICU mortality rate was slightly higher (33%) than in the previously mentioned studies. [7,13] However, the predicted mortality (based on APACHE II score) in our group of patients was higher than that reported by Cruz et al [13] for both non-survivors (71% vs. 51%) and survivors (40% vs. 22%). As Khan et al [7] used APACHE III score, direct comparisons cannot be made.…”

“…the result of progressive primary or recurrent/refractory disease, or the result of complications of immunosuppressive treatment. To our knowledge, there are only two previous studies [7,13] describing the outcome of patients with vasculitis admitted to the ICU in detail and assessing the role of prognostic systems. In our study, all patients were ANCApositive.…”

Fulminant Wegener’s granulomatosis with multiorgan dysfunction

“…However, the dilemma remained, when to start cyclophosphamide therapy, which can be deleterious in patients with concomitant infection and sepsis [5,10]. In patients with severe systemic necrotizing vasculitis treated in ICU, the majority of deaths are due to sepsis [12]. Severe treatment-related infections occur in approximately 10% of cases treated with cyclophosphamide and are a significant cause of mortality.…”