Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit.
OBJECTIVE
To determine prognostic factors in patients with systemic rheumatic diseases admitted to the intensive care unit (ICU) and to examine whether the observed mortality rate is predicted using the Acute Physiology And Chronic Health Assessment II (APACHE II) score.


METHODS
Retrospective study with historical controls in a 31-bed medicosurgical ICU at a university hospital.


METHODS
Seventy-one patients admitted to the ICU for an acute illness related to a systemic rheumatic disease and/or its treatment and 353 ICU control patients.


RESULTS
Systemic rheumatic diseases were mainly rheumatoid arthritis and vasculitides. In-hospital mortality rate was 28/71 (39%), including 23 patients who died in the ICU. Multivariable logistic regression showed that poor prior health status (Berdit's classification), APACHE II score, and admission for infection were associated with mortality, whereas prior use of immunosuppressive agents was not. APACHE II score at admission was higher in nonsurvivors (22+/-9) than in survivors (17+/-5) (p<0.01). The standard mortality ratio, i.e., the ratio between observed and predicted mortality, was 1.7 in the 71 study patients and 1.0 in the 353 control patients (p<0.0001).


CONCLUSIONS
In patients with systemic rheumatic diseases admitted to the ICU for at least 48 h, poor prior chronic health status, APACHE II score, and infection were prognostic factors for in-hospital mortality. SMR was higher than in a control ICU population.
Moreels
Mickaël
M
Departments of Intensive Care Medicine and Internal Medicine, Erasme University Hospital, Lennik Road 808, 1070 Brussels, Belgium.
Mélot
Christian
C
Leeman
Marc
M
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*