title: An audit of patients with rheumatic disease requiring medical intensive care.
abstract: BACKGROUND
  Medical intensive care for patients with rheumatic disease is usually complicated by significant morbidity and mortality. The aims of this study were to examine the reasons for admission, the outcomes of these patients and the possible prognostic factors in an Asian cohort.
  
  
  METHODS
  This was a retrospective study of the case records of 29 admissions to the medical intensive care unit (MICU) of Tan Tock Seng Hospital (TTSH) from August 1999 to August 2000.
  
  
  RESULTS
  There were 28 patients admitted, of whom 1 had a repeat admission. The majority of these patients were young (mean age 38.9 +/- 16.3 years) and 71.4% were females. Twenty patients (71.4%) had systemic lupus erythematosus (SLE). The main reasons for admission were infection/sepsis syndrome (n = 18), hypotension (n = 16) and acute respiratory failure (n = 14). The observed in-hospital mortality was 64.3%, which was higher than the predicted risk of hospital death of 47.3%. Infection contributed to 55.6% of deaths. The patients who died had a longer mean duration of the rheumatic disease, higher APACHE II scores, higher rates of hypertension and hyperlipidaemia, higher doses of steroid and immunosuppressive therapy and more organ failures. Renal failure and acute respiratory distress syndrome were the two most common organ failures in patients who died.
  
  
  CONCLUSIONS
  Many of our critically-ill patients with rheumatic disease were young females with good functional status. Despite the high mortality, they should be aggressively treated because infection and acute respiratory failure are potentially reversible.
authors.affiliation: Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. bernard_thong@notes.ttsh.gov.sg
authors.forename: B Y
authors.initials: BY
authors.lastname: Thong
authors.forename: D Y
authors.initials: DY
authors.lastname: Tai
authors.forename: S K
authors.initials: SK
authors.lastname: Goh
authors.forename: A
authors.initials: A
authors.lastname: Johan
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness; D003710:Demography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000453:epidemiology* / Q000628:therapy*