A study of Thai patients with systemic lupus erythematosus in the medical intensive care unit: epidemiology and predictors of mortality

Abstract

In this retrospective study, we described demographic information, reasons for admission, APACHE II severity scores, complications, mortality rate, causes of death and prognostic factors in 61 Thai patients with systemic lupus erythematosus (SLE) who were admitted to the medical intensive care unit (ICU) over a six-year period. The overall mortality rate during ICU hospitalization was 57% and the most common cause of death was infection, especially in the lower respiratory tract. The mean (SD) APACHE II score was 24.8 (10.8). SLE patients who had an APACHE II score of 20 or more were up to 65% of the patient population and had a significantly lower probability of survival based on Kaplan-Meier results (p = 0.004). The need for vasopressor therapy was significantly higher in patients who did not survive (OR = 6.98, 95% CI = 1.91-25.49). The patients who developed ventilator-associated pneumonia had a numerically higher mortality, which was not statistically significant (OR = 4.17, 95% CI = 0.91-19.03). The use of azathioprine as a steroid-sparing agent for SLE was associated with lower mortality rates (OR = 0.08, 95% CI = 0.01-0.58). Our findings emphasize that Thai SLE patients admitted to the medical ICU has a high mortality rate and early aggressive treatments are warranted.

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

“…Finally, sepsis was associated with nearly half of all hospital days and aggregate hospital charges among ICU admissions with SLE. Hospital mortality among septic ICU admissions with SLE was the lowest reported to date (9.9% vs. 31% [21] to 64% [11], respectively). Our results likely reflect differences in baseline patient characteristics and care of SLE, more selective triage to the ICU due to lower availability of ICU beds outside the US [21,42,43], and possibly improved critical care over time.…”

“…Infections are reported as the most common cause of ICU admission of patients with SLE [6], with frequency ranging from 14% [10] to 82% [11]. However, it is the development of sepsis among infected patients that is a key driver of morbidity, mortality [12,13] and increased use of healthcare resources [14], including critical care [15] in the general population and likely in SLE.…”

“…Numerous studies have described infections among ICU-managed SLE patients [11,[17][18][19][20][21][22][23]. However, sepsis affects only about half of ICU patients with an infection in the general population [15] and inferences about sepsis in studies of ICU-managed SLE patients with infections are limited in part because investigators have often conflated infection and sepsis.…”

“…Thus, sepsis was either not mentioned [19], not defined [17], used interchangeably with infection [22], or used as a category of site-specific infections [20]. The generalizability of prior studies is further affected by use of single-centered [11, 17-19, 22, 23], small cohort data [11, 17-19, 21, 22], with most of the data being over a decade old [11,[17][18][19][20]23]. Finally, sepsis was generally not the primary focus of most studies of ICU-managed SLE patients to date [11, 17-20, 22, 23].…”

Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

“…Rheumatological diseases (RD) are a heterogeneous group of entities with a chronic course and multisystemic involvement associated with significant morbidity and mortality. The complexity of the management of these diseases in the intensive care unit (ICU) lies in the fact that their complications do not derive only from the activity of RD, but from other associated factors such as the side effects of treatment and the lower functional reserve derived from cumulative damage to this type of diseases [1,2].…”