Prognostic factors for hospital mortality and ICU admission in patients with ANCA-related pulmonary vasculitis.
BACKGROUND
The objective of this study was to evaluate the factors predictive of 28-day mortality and admission to Intensive Care Unit (ICU) in patients with ANCA-related pulmonary vasculitis.


METHODS
We reviewed the medical records and imaging studies of 65 patients diagnosed with ANCA-related vasculitis hospitalized with pulmonary complications between February 1985 and November 2002. All patients underwent open or video-assisted thoracoscopic lung biopsy, had a positive ANCA serology, and were negative for glomerular basement membrane antibodies.


RESULTS
At presentation, 72% had dyspnea, 68% fever, 47% cough, 45% elevated blood pressure, 32.3% hemoptysis, 26.1% sinus involvement, 15% renal failure, and 4.6% scleritis. Pathological findings included alveolar hemorrhage (60%), granulomatous inflammation (46%), and capillaritis (38%). A significant number required mechanical ventilation (27.7%), hemodialysis (24.6%), continuous renal replacement therapy (3.1%), and plasmapheresis (3.1%). The 28-day mortality was 16.9% (11/65). Mechanical ventilation (OR 68, P < 0.005), admission to ICU (OR 18.5, P < 0.01), and blood transfusion (OR 22.4, P < 0.004) were strong predictors of increased mortality within 28 days after admission. Respiratory failure (OR 31, P < 0.0007), hemoptysis (OR 2.9, P < 0.06), smoking (OR 5.9, P < 0.02), and acute renal failure (OR 7.8, P < 0.01) were also predictors for admission to the ICU.


CONCLUSIONS
In patients with ANCA-related pulmonary vasculitis several clinical factors, but not pathologic findings or ANCA titers, are associated with ICU admission and/or 28-day mortality.
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. fholgui@emory.edu
Fernando
F
Holguin
Bassel
B
Ramadan
Anthony A
AA
Gal
Jesse
J
Roman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001706:Biopsy; D001803:Blood Transfusion; D002648:Child; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008168:Lung / Q000098:blood supply / Q000473:pathology; D008171:Lung Diseases / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D010956:Plasmapheresis; D011379:Prognosis; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014657:Vasculitis / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality
D019268:Antibodies, Antineutrophil Cytoplasmic