Survival of patients with SLE admitted to an intensive care unit—a retrospective study

Whitelaw, D. M.; Gopal, Razeen; Freeman, Victoria A.

doi:10.1007/s10067-004-1007-3

Cited by 27 publications

(19 citation statements)

References 20 publications

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“…We agree with earlier authors [37,38] who have stated that determining with any certainty whether patients died from infection or active SLE is difficult, since infections exacerbate SLE activity, leading to the necessity of treatment with immunosuppressive drugs, which in turn leads to increased risk of serious infections. Our study is in agreement with these earlier ones in finding that most of our patients who had severe infection also had active disease and renal involvement, which is also a major cause of death in SLE patients [6,14,[39][40][41].…”

Section: Discussionsupporting

confidence: 93%

Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

2009

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A knowledge of the causes and risk factors of fatal infection in childhood lupus nephritis (LN) patients treated with intravenous cyclophosphamide (IVCY) is important to enable optimal treatment. During an 11-year period (1996-2007), severe infection cases occurred in 31/84 (36.9%) patients with 64 infection episodes in our central referral institution in southern Thailand. Fatal infections occurred in 13/31 (41.9%) patients, most (11/13, 84.6%) during the first infective episode. The major causative organisms of the fatal infections were fungus and Gram-negative bacilli. Fatal infections were more likely to occur in patients with a prior history of treatment with pulse methylprednisolone and in patients with more active LN, as evidenced by the higher proteinuria and serum creatinine levels and lower hemoglobin and lymphocyte counts in this group than in patients with non-fatal infections. Multivariate analysis indicated that factors associated with fatal infection were prior treatment with pulse methylprednisolone [odds ratio (OR) 11.2, 95% confidence interval (CI) 1.9-61.0], renal failure (OR 5.9, 95% CI 1.0-34.8), and fungal infection (OR 23.9, 95% CI 1.9-298.2). Cases of active LN treated with IVCY and pulse methylprednisolone who later develop severe infection that fails to respond to antibiotics should be carefully investigated for fungal infection.

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Section: Discussionsupporting

confidence: 93%

Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

2009

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“…The leading cause of admission was activity; this differs from several series, where infection plays a preponderant role [1,21,23]. Only a few cohorts report disease activity as a cause of hospitalization [25,26] and in some, as in the study by Whitelaw et al [27] more than half of the patients had less than six months of diagnosis of SLE, which would explain the predominance of activity. In the present cohort, the average time of diagnosis was two years; the high activity was possibly a reflection of difficulties in outpatient management.…”

Section: Discussionmentioning

confidence: 72%

Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

et al. 2019

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Objective: Describe the clinical and epidemiologic characteristics of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU). Methods: a retrospective study with medical records review of patients with systemic lupus erythematosus (SLE) admitted to the ICU between 2004 and 2015 were included. Qualitative variables were described using absolute and relative frequencies. For quantitative variables mean value and standard deviation (SD) or median value with the interquartile range (IQR) depending on data distribution. To compare groups, it was used the Student t-test or Mann Whitney U test as appropriate and Fisher's exact test. Results: 33 patients were included, with a total of 45 ICU admissions, 29 (87.9%) were females with a median age of 26 years. The median time of diagnosis of SLE was two years, (IQR 1.5-5). The most common SLE manifestation and comorbidity were renal disease and hypertension with 27 (81.8%) and 14 (42.4%) respectively. The main reason for admittance was lupus flare with 25 events (55.5%). Infection was the second cause of admission with 19 events (42.2%). The median stay time in the ICU was four days (IQR 2-7). LODS score was 6 (RIQ 5-8), and APACHE II score was 13 (RIQ 11-17.7). There were 29 infections (64.5%) of which 20 (69%) were hospital-acquired. Four (12.1%) patients died. Conclusion: Unlike most of the previously reported series, in this study SLE activity was the most common cause of admission in the ICU. A more aggressive disease and difficulties in the ambulatory setting could explain this behavior. Despite the higher percentage of lupus flares, there was lower mortality.

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“…Individuals with SLE may present to autopsy for a number of reasons. One involves the multifactorial nature of the underlying disease processes, with attending doctors being unable to determine the precise cause of death because of the complexity and subtlety of manifestations (21). An autopsy may also be required if death is unexpected.…”

Section: Diagnosis and Outcomementioning

confidence: 99%

Lethal Manifestations of Systemic Lupus Erythematosus in a Forensic Context

Nicklin

Byard

2011

Journal of Forensic Sciences

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Systemic lupus erythematosus is an autoimmune connective tissue disorder that affects multiple organs. While the clinical manifestations may vary in intensity over time and be associated with chronic disease, occasional cases occur where sudden and unexpected death has occurred. Cardiovascular disease is common, with accelerated atherosclerosis, intravascular thrombosis associated with antiphospholipid syndrome, and hypertensive cardiomegaly. Vasculitis with superimposed thrombosis may result in critical reduction in blood to vital organs, such as the heart and brain with infarction. Mesenteric ischemia may be caused by vasculitis, thrombosis, and accelerated atherosclerosis and may result in lethal intestinal infarction. Other diverse causes of sudden death include myocarditis, epilepsy, pulmonary hypertension, pulmonary thromboembolism, and sepsis. The autopsy evaluation of such cases requires careful examination of all organs with extensive histological sampling to include blood vessels, and microbiological sampling for bacteria, viruses, and fungi.

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Survival of patients with SLE admitted to an intensive care unit—a retrospective study

Cited by 27 publications

References 20 publications

Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

Lethal Manifestations of Systemic Lupus Erythematosus in a Forensic Context

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