title: Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study.
abstract: BACKGROUND
  Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities.
  
  
  METHODS
  This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis.
  
  
  RESULTS
  Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival.
  
  
  CONCLUSIONS
  In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Dumas
authors.affiliation: Medical Intensive Care Unit, Cochin Teaching Hospital, Paris.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Géri
authors.affiliation: Biostatistics Department, Saint-Louis Teaching Hospital, Paris.
authors.forename: Claire
authors.initials: C
authors.lastname: Montlahuc
authors.affiliation: Medical Intensive Care Unit, Bichat Hospital, Paris.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chemam
authors.affiliation: Service de réanimation médicale, Institut de Cardiologie, Pitié-Salpêtrière Teaching Hospital, Paris.
authors.forename: Laurence
authors.initials: L
authors.lastname: Dangers
authors.affiliation: Réanimation médicale, Saint-Antoine Teaching Hospital, Paris.
authors.forename: Claire
authors.initials: C
authors.lastname: Pichereau
authors.affiliation: Service de réanimation médicale, Institut de Cardiologie, Pitié-Salpêtrière Teaching Hospital, Paris.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Brechot
authors.affiliation: Service de réanimation médicale, Institut de Cardiologie, Pitié-Salpêtrière Teaching Hospital, Paris.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Duprey
authors.affiliation: Medical Intensive Care Unit, Pitié-Salpêtrière Teaching Hospital, Paris.
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.affiliation: Medical Intensive Care Unit, Hautepierre Teaching Hospital, Strasbourg.
authors.forename: Maleka
authors.initials: M
authors.lastname: Schenck
authors.affiliation: Medical Intensive Care Unit, Nouvel Hôpital Civil, Strasbourg Teaching Hospital, Strasbourg.
authors.forename: Julie
authors.initials: J
authors.lastname: Boisramé-Helms
authors.affiliation: Assistance-Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses respiratoires et des Infections Sévères, Marseille.
authors.forename: Guillemette
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Réanimation médicale, Hôpital de la Croix-Rousse, Lyon.
authors.forename: Loredana
authors.initials: L
authors.lastname: Baboi
authors.affiliation: Université Paris-Descartes, Department of Internal Medicine, Cochin Teaching Hospital, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Mouthon
authors.affiliation: Department of Internal Medicine, Pitié-Salpêtrière Teaching Hospital, Paris.
authors.forename: Zair
authors.initials: Z
authors.lastname: Amoura
authors.affiliation: Assistance-Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses respiratoires et des Infections Sévères, Marseille; Department of Internal Medicine, Bichat Hospital, Paris.
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.affiliation: Department of Internal Medicine, Saint-Louis Teaching Hospital, Paris.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
authors.affiliation: Biostatistics Department, Saint-Louis Teaching Hospital, Paris.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Medical Intensive Care Unit, Cochin Teaching Hospital, Paris.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris. Electronic address: elie.azoulay@sls.aphp.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends