title: Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases.
abstract: BACKGROUND
  Knowledge about the clinical features, outcomes and predictors of short-term mortality in critically ill patients with systemic rheumatic disease (SRD) requires further characterization.
  
  
  METHODS
  Single center retrospective observational cohort study of 149 critically ill patients with SRD followed in a French medical intensive care unit over a 20-year period. Multivariate logistic regression was used to identify predictors of day-30 mortality.
  
  
  RESULTS
  Most patients (63%) had systemic lupus erythematosus, rheumatoid arthritis, or systemic sclerosis. The critical illness usually developed late after the diagnosis of SRD (median time to ICU admission 82 months, IQR [9-175] in the 127 patients with a previous diagnosis of SRD). Two-thirds of patients were taking immunosuppressive drugs to treat their SRD. Reasons for ICU admission were infection (47%), SRD exacerbation (48%), and iatrogenic complications (11%); the most common organ failure was acute renal failure. Thirty-day mortality was 16%. Predictors of 30-day mortality were the LODS score on day 1 (OR 1.3 (1.06-1.48)), bacterial pneumonia (OR 3.8 (1.03-14.25)), need for vasoactive drugs (OR 7.1 (1.83-27.68)), SRD exacerbation (OR 4.3 (1.15-16.53)), and dermatomyositis (OR 9.2 (1.05-80.78)) as the underlying disease. Year of ICU admission was not significantly associated with 30-day survival.
  
  
  CONCLUSIONS
  Patients with SRD are mostly admitted in the ICU with infection or SRD exacerbation, and can be treated with immunosuppressive therapy and life-sustaining interventions with acceptable 30-day mortality. Death is associated with both the severity of the acute medical condition and the characteristics of the underlying SRD.
authors: AP-HP, Hôpital Saint-Louis, Medical ICU, Paris, France.
authors: Stanislas
authors: S
authors: Faguer
authors: Magali
authors: M
authors: Ciroldi
authors: Eric
authors: E
authors: Mariotte
authors: Lionel
authors: L
authors: Galicier
authors: Michel
authors: M
authors: Rybojad
authors: Emmanuel
authors: E
authors: Canet
authors: Djaouida
authors: D
authors: Bengoufa
authors: Benoit
authors: B
authors: Schlemmer
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007239:Infections / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010043:Outcome and Process Assessment, Health Care; D062072:Patient Acuity; D011379:Prognosis; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents