Acute abdominal pain in patients with systemic lupus erythematosus.
BACKGROUND
Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk.


METHODS
We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission.


RESULTS
Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001).


CONCLUSIONS
This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga No. 15, Col. Seccion XVI Tlalpan, Mexico City, CP, 14000, Mexico. omarvergara74@hotmail.com
Omar
O
Vergara-Fernandez
Jorge
J
Zeron-Medina
Carlos
C
Mendez-Probst
Noel
N
Salgado-Nesme
Daniel
D
Borja-Cacho
Jorge
J
Sanchez-Guerrero
Heriberto
H
Medina-Franco
D018806:APACHE; D015746:Abdominal Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult