title: Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study.
abstract: OBJECTIVE
  Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce.
  
  
  METHODS
  We included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group.
  
  
  RESULTS
  In the ICU group, patients predominantly showed granulomatosis with polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU group showed comparable Birmingham vasculitis activity score and a higher frequency of heart, central nervous system and lungs involvements. Respiratory assistance, renal replacement therapy and vasopressors were required in 68.0, 56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) patients died during the ICU stay. The following were significantly associated with ICU mortality in the univariate analysis: the need for respiratory assistance, the use of vasopressors, the occurrence of at least one infection event in ICU, cyclophosphamide treatment, sequential organ failure assessment at admission and simplified acute physiology score II. After adjustment on sequential organ failure assessment or infection, cyclophosphamide was no longer a risk factor for mortality. Despite a higher initial mortality rate of ICU patients within the first hospital stay (p < 0.0001), the long-term mortality of hospital survivors did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively, p = 0.36). Moreover, we observed no renal survival difference between groups after a 1-year follow-up (82.1 and 80.5%, p = 0.94).
  
  
  CONCLUSIONS
  This study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.|Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Demiselle
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: Johann
authors.initials: J
authors.lastname: Auchabie
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: François
authors.initials: F
authors.lastname: Beloncle
authors.affiliation: Service de Néphrologie et Immunologie Clinique, CHRU Tours, Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gatault
authors.affiliation: Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
authors.forename: Steven
authors.initials: S
authors.lastname: Grangé
authors.affiliation: Service de Réanimation Médicale, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Du Cheyron
authors.affiliation: Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dellamonica
authors.affiliation: Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Boyer
authors.affiliation: Medical Intensive Care Unit, Amiens University Medical Center, 80054, Amiens, Cedex 1, France.
authors.forename: Dimitri Titeca
authors.initials: DT
authors.lastname: Beauport
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.|Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.affiliation: Service de Réanimation Médicale, Hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.affiliation: Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, 30 bd Jean Monnet, 44093, Nantes, France.|UMR 1064, Inserm, 30 bd Jean Monnet, 44093, Nantes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Guitton
authors.affiliation: Service de Reanimation Medico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chudeau
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Réanimation, Centre de Réanimation Polyvalente, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Fourrier
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France.
authors.forename: René
authors.initials: R
authors.lastname: Robert
authors.affiliation: Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guérot
authors.affiliation: Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Boisramé-Helms
authors.affiliation: APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Galichon
authors.affiliation: Service de Réanimation Polyvalente, Hôpital Bretonneau, Tours, France.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Dequin
authors.affiliation: Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lautrette
authors.affiliation: Service de Réanimation Médicale, CHU de Nancy Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035, Nancy Cedex, France.
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Bollaert
authors.affiliation: Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.|EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
authors.affiliation: Département de Médecine Interne, Assistance Public des Hôpitaux de Paris, Hôpital Cochin, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France. nicolas.lerolle@univ-angers.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lerolle
authors.affiliation: Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Augusto
keywords: ANCA-associated vasculitis; Anti-neutrophil cytoplasmic antibody; Intensive care unit; Mortality