Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases

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• 作者：Stanislas Faguer ; Magali Ciroldi ; Eric Mariotte ; Lionel Galicier ; Michel Rybojad ; Emmanuel Canet ; Djaouida Bengoufa ; Benoit Schlemmer ; É ; lie Azoulay ; ^{elie.azoulay@sls.aphp.fr}
• 关键词：Inflammation ; ARDS ; Shock ; Immunocompromised patients ; Steroids
• 刊名：European Journal of Internal Medicine
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：24
• 期：3
• 页码：e40-e44
• 全文大小：248 K

文摘

Background

Knowledge about the clinical features, outcomes and predictors of short-term mortality in critically ill patients with systemic rheumatic disease (SRD) requires further characterization.

Methods

Single center retrospective observational cohort study of 149 critically ill patients with SRD followed in a French medical intensive care unit over a 20-year period. Multivariate logistic regression was used to identify predictors of day-30 mortality.

Results

Most patients (63 % ) had systemic lupus erythematosus, rheumatoid arthritis, or systemic sclerosis. The critical illness usually developed late after the diagnosis of SRD (median time to ICU admission 82 months, IQR [9-175] in the 127 patients with a previous diagnosis of SRD). Two-thirds of patients were taking immunosuppressive drugs to treat their SRD. Reasons for ICU admission were infection (47 % ), SRD exacerbation (48 % ), and iatrogenic complications (11 % ); the most common organ failure was acute renal failure. Thirty-day mortality was 16 % . Predictors of 30-day mortality were the LODS score on day 1 (OR 1.3 (1.06-1.48)), bacterial pneumonia (OR 3.8 (1.03-14.25)), need for vasoactive drugs (OR 7.1 (1.83-27.68)), SRD exacerbation (OR 4.3 (1.15-16.53)), and dermatomyositis (OR 9.2 (1.05-80.78)) as the underlying disease. Year of ICU admission was not significantly associated with 30-day survival.

Conclusion

Patients with SRD are mostly admitted in the ICU with infection or SRD exacerbation, and can be treated with immunosuppressive therapy and life-sustaining interventions with acceptable 30-day mortality. Death is associated with both the severity of the acute medical condition and the characteristics of the underlying SRD.