Predictors of lethal outcome in patients with immunoinflammatory diseases hospitalized in the intensive care unit

Systemic immunoinflammatory diseases can affect multiple systems and organs. They have a severe course and severe complications, causing multiple organ failure and death. Quite often these patients are required to be hospitalized in the intensive care unit (ICU). Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.

To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.

The retrospective continuous cohort study included 51 patients (23 males, 28 females) with immunoinflammatory diseases, including multisystem inflammatory syndrome associated with coronavirus disease 2019 (n = 18), systemic rheumatic diseases (n = 24), and generalized infections (n = 9). The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.

Thirteen patients (25.5%) died within 39 (17; 62) days after ICU admission. Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived (30 days vs 7 days, P = 0.013) and had a longer stay in the ICU (30 days vs 6 days, P = 0.003). The main predictors of the fatal outcome were age > 162 months [odds ratio (OR) = 10.7; 95% confidence interval (CI): 2.4-47.2], P = 0.0006], time to ICU admission > 26 days from the disease onset (OR = 12.0; 95%CI: 2.6-55.3, P = 0.008), preceding immune suppression treatment (OR = 6.2; 95%CI: 1.6-24.0, P = 0.013), invasive mycosis during the ICU stay (OR = 18.8; 95%CI: 1.9-184.1, P = 0.0005), systemic rheumatic diseases (OR = 7.2; 95%CI: 1.7-31.1, P = 0.004), and ICU stay over 15 days (OR = 19.1; 95%CI: 4.0-91.8, P = 0.00003). Multiple regression analysis (r ² = 0.422, P < 0.000002) identified two predictors of the fatal outcomes: Systemic rheumatic diseases (P = 0.015) and ICU stay over 15 days (P = 0.00002).

Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program. Avoiding ICU stays for patients with systemic rheumatic diseases, close monitoring, and preventing invasive mycosis might improve the outcome in children with systemic immune-mediated diseases.