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Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study
Guillaume Dumas1, Guillaume Géri2, Claire Montlahuc3
1Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris.
Chest
|May 22, 2015
Summary
Patients with systemic rheumatic diseases (SRDs) often require intensive care unit (ICU) admission due to infection or disease flares, primarily affecting the lungs. Direct ICU admission may lead to better outcomes for these critically ill patients.
Area of Science:
- Critical Care Medicine
- Rheumatology
- Internal Medicine
Background:
- Systemic rheumatic diseases (SRDs) can necessitate intensive care unit (ICU) admission for exacerbations, infections, or treatment toxicities.
- SRDs encompass conditions like connective tissue diseases (e.g., lupus) and systemic vasculitides.
Purpose of the Study:
- To identify determinants of ICU mortality in patients with SRDs.
- To analyze reasons for ICU admission and patient characteristics in this population.
Main Methods:
- Observational study conducted in 10 French university-affiliated ICUs.
- Inclusion of consecutive patients with SRDs.
- Multivariable logistic analysis to determine factors associated with ICU mortality.
Main Results:
- 381 admissions for 363 patients; 66.1% connective tissue disease, 26.2% systemic vasculitis.
- Common ICU admission reasons: infection (39.9%), SRD exacerbation (34.4%), respiratory involvement (56.8%), shock (41.5%), acute kidney injury (42.2%).
- ICU mortality rate was 21.0%; mortality associated with shock, higher SOFA score, and non-direct admission.
Conclusions:
- Critical care is primarily for patients with known SRDs, though diagnosis in ICU occurs in 12%.
- Infections and SRD exacerbations, mainly affecting the lungs, are the leading causes for ICU admission.
- Direct ICU admission appears to be associated with improved outcomes.
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