title: Outcome of patients with small-vessel vasculitis admitted to a medical ICU.
abstract: OBJECTIVE
  This study aims to describe the clinical course and prognostic factors of patients with small-vessel vasculitis admitted to a medical ICU.
  
  
  METHODS
  We reviewed the clinical records of 38 patients with small-vessel vasculitis admitted consecutively to the ICU between January 1997 and May 2004. The APACHE (acute physiology and chronic health evaluation) III prognostic system was used to determine the severity of illness on the first ICU day; the sequential organ failure assessment (SOFA) score was used to measure organ dysfunction, and the Birmingham vasculitis activity score for Wegener granulomatosis (BVAS/WG) was used to assess vasculitis activity. Outcome measures were the 28-day mortality and ICU length of stay.
  
  
  RESULTS
  Nineteen patients (50%) had Wegener granulomatosis, 16 patients (42%) had microscopic polyangiitis, 2 patients had CNS vasculitis, and 1 patient had Churg-Strauss syndrome. Reasons for ICU admission included alveolar hemorrhage in 14 patients (37%), sepsis in 5 patients (13%), seizures in 3 patients (8%), and pneumonia in 2 patients (5%). The median ICU length of stay was 4.0 days (interquartile range, 2.0 to 6.0 days). The APACHE III score was lower in survivors than nonsurvivors (p = 0.010). The predicted hospital mortality was 54% for nonsurvivors and 21% for survivors (p = 0.0038). The mean SOFA score was 11.6 (SD, 2.6) in nonsurvivors, compared to 6.9 (SD, 2.4) in survivors (p = 0.0004). Mean BVAS/WG scores were 8.6 (SD, 3.6) in nonsurvivors and 4.7 (SD, 4.6) in survivors (p = 0.0889). Twenty-six percent of the patients received invasive mechanical ventilation, and 33% underwent dialysis. The 28-day and 1-year mortality rates were 11% and 29%, respectively.
  
  
  CONCLUSIONS
  The mortality of patients with small-vessel vasculitis admitted to the ICU is lower than predicted, and alveolar hemorrhage is the most common reason for ICU admission.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: S Anjum
authors.initials: SA
authors.lastname: Khan
authors.forename: Mir Rauf
authors.initials: MR
authors.lastname: Subla
authors.forename: Deepti
authors.initials: D
authors.lastname: Behl
authors.forename: Ulrich
authors.initials: U
authors.lastname: Specks
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
mesh_terms: D000368:Aged; D001706:Biopsy; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006469:Hemoptysis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010488:Polyarteritis Nodosa / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020293:Vasculitis, Central Nervous System / Q000150:complications / Q000175:diagnosis* / Q000401:mortality