Marco Ulises Martinez-Martinez1, Anne K Sturbaum1, Jorge Alcocer-Varela1, Javier Merayo-Chalico1, Diana Gómez-Martin1, José de Jesús Eduardo Gómez-Bañuelos1, Miguel Ángel Saavedra1, Sandra Enciso-Peláez1, Enrique Faugier-Fuentes1, Rocío Maldonado-Velázquez1, Luz María Suárez-Larios1, David Vega-Morales1, Julio César Casasola-Vargas1, Diego Luis Carrillo Pérez1, Andy Abril1, Ronald Butendieck1, Fedra Irazoque-Palazuelos1, Carlos Abud-Mendoza2. 1. From the Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosi, S.L.P.; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social (IMSS) México D.F.; Hospital Infantil de México, Mexico City; Hospital Infantil del Estado de Sonora, Hermosillo, Sonora; Hospital Universitario de Nuevo León, Monterrey, Nuevo León; Hospital General de México, México D.F.; Hospital 20 de Noviembre ISSSTE, Mexico City, Mexico; Mayo Clinic, Jacksonville, Florida, USA.M.U. Martinez-Martinez, MD; A.K. Sturbaum, MD, Hospital Central "Dr. Ignacio Morones Prieto"; J. Alcocer-Varela, MD; J. Merayo-Chalico, MD; D. Gómez-Martin, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J.D.J.E. Gómez-Bañuelos, MD; M.Á. Saavedra, MD, Centro Médico Nacional "La Raza", IMSS; S. Enciso-Peláez, MD; E. Faugier-Fuentes, MD; R. Maldonado-Velázquez, MD, Hospital Infantil de México; L.M. Suárez-Larios, MD, Hospital Infantil del Estado de Sonora; D. Vega-Morales, MD, Hospital Universitario de Nuevo León; J.C. Casasola-Vargas, MD, Hospital General de México; D.L. Carrillo Pérez, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Abril, MD; R. Butendieck, MD, Mayo Clinic Jacksonville; F. Irazoque-Palazuelos, MD, Hospital 20 de Noviembre ISSSTE; C. Abud-Mendoza, MD, Hospital Central "Dr. Ignacio Morones Prieto". 2. From the Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosi, S.L.P.; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social (IMSS) México D.F.; Hospital Infantil de México, Mexico City; Hospital Infantil del Estado de Sonora, Hermosillo, Sonora; Hospital Universitario de Nuevo León, Monterrey, Nuevo León; Hospital General de México, México D.F.; Hospital 20 de Noviembre ISSSTE, Mexico City, Mexico; Mayo Clinic, Jacksonville, Florida, USA.M.U. Martinez-Martinez, MD; A.K. Sturbaum, MD, Hospital Central "Dr. Ignacio Morones Prieto"; J. Alcocer-Varela, MD; J. Merayo-Chalico, MD; D. Gómez-Martin, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J.D.J.E. Gómez-Bañuelos, MD; M.Á. Saavedra, MD, Centro Médico Nacional "La Raza", IMSS; S. Enciso-Peláez, MD; E. Faugier-Fuentes, MD; R. Maldonado-Velázquez, MD, Hospital Infantil de México; L.M. Suárez-Larios, MD, Hospital Infantil del Estado de Sonora; D. Vega-Morales, MD, Hospital Universitario de Nuevo León; J.C. Casasola-Vargas, MD, Hospital General de México; D.L. Carrillo Pérez, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Abril, MD; R. Butendieck, MD, Mayo Clinic Jacksonville; F. Irazoque-Palazuelos, MD, Hospital 20 de Noviembre ISSSTE; C. Abud-Mendoza, MD, Hospital Central "Dr. Ignacio Morones Prieto". c_abud@hotmail.com.
Abstract
OBJECTIVE: To evaluate factors associated with mortality and infections in patients with systemic lupus erythematosus (SLE) and diffuse alveolar hemorrhage (DAH). METHODS: A retrospective chart review was carried out for medical admissions of patients with a diagnosis of SLE and DAH in 9 hospitals. Clinical and laboratory data were recorded for each patient at DAH diagnosis. RESULTS: We included 57 episodes of DAH of 50 patients (7 recurrences), 49 women (86%), 14 juvenile SLE (24.6%); 24 had died (42.1%). In the chart review we detected infection in 22 episodes (38.6%): 8 invasive fungal infections, 16 bacterial infections, and 2 patients had both types. In the bivariate analysis, factors associated with mortality were high Acute Physiology and Chronic Health Evaluation II scores, requirement of mechanical ventilation (OR 15.0, 95% CI 1.9 to 662.2), infections (fungal or bacterial; OR 3.2, CI 0.9 to 11.1), renal failure (OR 4.9, CI 1.4 to 18.0), and thrombocytopenia (OR 4.3, CI 1.2 to 15.6). We found similar mortality between children and adults. Infections were associated with treatment for SLE, requirement of mechanical ventilation, hypocomplementemia, and high levels of C-reactive protein. CONCLUSION: Infection is a frequent finding in patients with DAH and SLE; we found similar mortality between adult SLE and juvenile SLE. Factors that we describe associated with infections may influence the therapeutic selection for these patients.
OBJECTIVE: To evaluate factors associated with mortality and infections in patients with systemic lupus erythematosus (SLE) and diffuse alveolar hemorrhage (DAH). METHODS: A retrospective chart review was carried out for medical admissions of patients with a diagnosis of SLE and DAH in 9 hospitals. Clinical and laboratory data were recorded for each patient at DAH diagnosis. RESULTS: We included 57 episodes of DAH of 50 patients (7 recurrences), 49 women (86%), 14 juvenile SLE (24.6%); 24 had died (42.1%). In the chart review we detected infection in 22 episodes (38.6%): 8 invasive fungal infections, 16 bacterial infections, and 2 patients had both types. In the bivariate analysis, factors associated with mortality were high Acute Physiology and Chronic Health Evaluation II scores, requirement of mechanical ventilation (OR 15.0, 95% CI 1.9 to 662.2), infections (fungal or bacterial; OR 3.2, CI 0.9 to 11.1), renal failure (OR 4.9, CI 1.4 to 18.0), and thrombocytopenia (OR 4.3, CI 1.2 to 15.6). We found similar mortality between children and adults. Infections were associated with treatment for SLE, requirement of mechanical ventilation, hypocomplementemia, and high levels of C-reactive protein. CONCLUSION: Infection is a frequent finding in patients with DAH and SLE; we found similar mortality between adult SLE and juvenile SLE. Factors that we describe associated with infections may influence the therapeutic selection for these patients.
Authors: Dai Kimura; Samir Shah; Mario Briceno-Medina; Shyam Sathanandam; Brent Haberman; Jie Zhang; Linda Myers; Tk Susheel Kumar; Christopher Knott-Craig Journal: J Intensive Care Date: 2015-03-07