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Outcomes and Prognostic Factors in Patients with Rheumatologic Diseases Admitted to the ICU
Tanja Brünnler1, Miriam Susewind, Ute Hoffmann
1Emergency Department, Hospital of Barmherzige Brüder, Germany.
Internal Medicine (Tokyo, Japan)
|August 18, 2015
Summary
Critically ill patients with rheumatic diseases have worse outcomes than other patient groups. Key mortality risk factors include high Apache II scores and need for mechanical ventilation or renal replacement therapy.
Area of Science:
- Critical Care Medicine
- Rheumatology
- Internal Medicine
Background:
- Rheumatic diseases encompass a range of autoimmune and inflammatory conditions.
- Patients with rheumatic diseases admitted to the intensive care unit (ICU) may face unique challenges and poorer prognoses.
Purpose of the Study:
- To evaluate the outcomes of patients with rheumatic diseases admitted to the ICU.
- To identify risk factors associated with mortality in this patient population.
Main Methods:
- Retrospective chart analysis of 108 patients with various rheumatic diseases admitted to a tertiary university medical center's ICU.
- Assessment of morbidity and mortality in relation to underlying diseases, treatments, and complications.
Main Results:
- The cohort included patients with rheumatoid arthritis, spondyloarthritis, vasculitis, connective tissue diseases, and other rheumatologic conditions.
- Common ICU admission reasons were infection (30%), cardiovascular (22%), and gastrointestinal (18%) complications.
- ICU and hospital mortality rates were 16% and 20%, respectively. Fatal outcomes were primarily linked to infectious complications (46%) and disease exacerbation (14%).
- Risk factors for mortality included elevated Apache II score, mechanical ventilation, renal replacement therapy, vasopressor use, and plasma exchange therapy.
Conclusions:
- Critically ill patients with rheumatic diseases experience impaired outcomes compared to other patient groups.
- No significant differences in outcomes were observed between different rheumatic disease subtypes or based on immunosuppressive therapy use.
- Specific factors like high Apache II scores and intensive treatments predict mortality.
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