Autoimmune diseases in the intensive care unit. An update

Area of Science:

• Immunology
• Critical Care Medicine
• Internal Medicine

Background:

• Autoimmune diseases (ADs) present significant challenges in the intensive care unit (ICU).
• Advances in diagnosis and treatment offer new management strategies for critical care patients with ADs.
• Understanding admission causes, clinical features, and outcomes is crucial for improving patient care.

Purpose of the Study:

• To review admission causes, clinical features, outcomes, and mortality predictors for patients with ADs in the ICU.
• To identify key variables associated with mortality in critically ill patients with ADs.
• To inform critical care management of patients with autoimmune conditions.

Main Methods:

• Systematic review of case series and case reports up to December 2011.
• Inclusion of patients based on International Classification criteria for ADs.
• Analysis of data from PubMed, SCOPUS, SciELO, and LILACS databases.

Main Results:

• Respiratory involvement was the primary reason for ICU admission.
• Systemic lupus erythematosus (SLE), rheumatoid arthritis, and systemic vasculitis were the most common ADs.
• Mortality rates varied, reaching up to 79% for SLE-specific cases; high APACHE score, multi-organ dysfunction, older age, and cytopenia were linked to mortality.

Conclusions:

• Autoimmune diseases must be considered in patients with critical, life-threatening conditions requiring ICU admission.
• Prompt identification of mortality-influencing variables is essential for enhancing patient outcomes.
• Improved critical care protocols for AD patients are needed.