title: The prognostic significance of the Birmingham Vasculitis Activity Score (BVAS) with systemic vasculitis patients transferred to the intensive care unit (ICU).
abstract: Systemic vasculitides represent a heterogeneous group of diseases that share clinical features including respiratory distress, renal dysfunction, and neurologic disorders. These diseases may often cause life-threatening complications requiring admission to an intensive care unit (ICU). The aim of the study was to evaluate the validity and responsiveness of Birmingham Vasculitis Activity Score (BVAS) score to predict survival in patients with systemic vasculitides admitted to ICU.A retrospective study was carried out from 2004 to 2014 in 18 patients with systemic vasculitis admitted to 2 different Rheumatology divisions and transferred to ICU due to clinical worsening, with a length of stay beyond 24 hours. We found that ICU mortality was significantly associated with higher BVAS scores performed in the ward (P = 0.01) and at the admission in ICU (P = 0.01), regardless of the value of Acute Physiology And Chronic Health Evaluation (APACHE II) scores (P = 0.50). We used receiver-operator characteristic (ROC) curve analysis to evaluate the possible cutoff value for the BVAS in the ward and in ICU and we found that a BVAS > 8 in the ward and that a BVAS > 10 in ICU might be a useful tool to predict in-ICU mortality.BVAS appears to be an excellent tool for assessing ICU mortality risk of systemic vasculitides patients admitted to specialty departments. Our experience has shown that performing the assessment at admission to the ward is more important than determining the evaluation before the clinical aggravation causing the transfer to ICU.
authors.affiliation: Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome Operative Unit of Rheumatology, Department of Internal Medicine, University of Padua, Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Biscetti
authors.forename: Angela
authors.initials: A
authors.lastname: Carbonella
authors.forename: Federico
authors.initials: F
authors.lastname: Parisi
authors.forename: Silvia Laura
authors.initials: SL
authors.lastname: Bosello
authors.forename: Franco
authors.initials: F
authors.lastname: Schiavon
authors.forename: Roberto
authors.initials: R
authors.lastname: Padoan
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014657:Vasculitis / Q000401:mortality*