Guillaume Dumas1, Guillaume Géri2, Claire Montlahuc3, Sarah Chemam4, Laurence Dangers5, Claire Pichereau6, Nicolas Brechot5, Matthieu Duprey5, Julien Mayaux7, Maleka Schenck8, Julie Boisramé-Helms9, Guillemette Thomas10, Loredana Baboi11, Luc Mouthon12, Zair Amoura13, Thomas Papo14, Alfred Mahr15, Sylvie Chevret3, Jean-Daniel Chiche2, Elie Azoulay16. 1. Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris. 2. Medical Intensive Care Unit, Cochin Teaching Hospital, Paris. 3. Biostatistics Department, Saint-Louis Teaching Hospital, Paris. 4. Medical Intensive Care Unit, Bichat Hospital, Paris. 5. Service de réanimation médicale, Institut de Cardiologie, Pitié-Salpêtrière Teaching Hospital, Paris. 6. Réanimation médicale, Saint-Antoine Teaching Hospital, Paris. 7. Medical Intensive Care Unit, Pitié-Salpêtrière Teaching Hospital, Paris. 8. Medical Intensive Care Unit, Hautepierre Teaching Hospital, Strasbourg. 9. Medical Intensive Care Unit, Nouvel Hôpital Civil, Strasbourg Teaching Hospital, Strasbourg. 10. Assistance-Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses respiratoires et des Infections Sévères, Marseille. 11. Réanimation médicale, Hôpital de la Croix-Rousse, Lyon. 12. Université Paris-Descartes, Department of Internal Medicine, Cochin Teaching Hospital, Paris, France. 13. Department of Internal Medicine, Pitié-Salpêtrière Teaching Hospital, Paris. 14. Assistance-Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses respiratoires et des Infections Sévères, Marseille; Department of Internal Medicine, Bichat Hospital, Paris. 15. Department of Internal Medicine, Saint-Louis Teaching Hospital, Paris. 16. Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris. Electronic address: elie.azoulay@sls.aphp.fr.
Abstract
BACKGROUND: Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities. METHODS: This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis. RESULTS: Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival. CONCLUSIONS: In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
BACKGROUND:Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities. METHODS: This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis. RESULTS: Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival. CONCLUSIONS: In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
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