Determination of the main causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted to the medical intensive care unit in Southern Iran

Abstract

Background Systemic rheumatic diseases (SRD) are a heterogeneous group of diseases that can involve several organ systems and occasionally requires intensive care unit (ICU) admission because of severe systemic disease, life-threatening organ involvement, or complication of treatment. The objective of this study is to determine the causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted in teaching medical ICUs in southern Iran. Methods A retrospective case review of all patients with rheumatologic diseases admitted in the academic medical ICUs in two referral hospitals in southern Iran, from March 2015 to January 2020. Patients’ data were documented from their hospital records and the cause of admission, in-hospital outcome, and prognostic factors was evaluated. Results Ninety-one patients were included, of which 71.4% were female. Systemic lupus erythematosus (54.9%) was the most common disease. Nineteen (20.9%) patients were new cases of rheumatological disease. The most frequent symptom for admittance was dyspnea (54.9%) and hemoptysis (20.9%). The in-hospital mortality rate was 48%, and the leading cause of death was infection (29 patients; 65.5%) followed by disease activity (18 patients; 40.9%). Also, the death of 29.5% of patients was presumed due to both disease activity and infection. Factors associated with mortality included renal insufficiency ( p < 0.028), infection ( p < 0.001), pneumonia ( p < 0.042), dyspnea ( p < 0.042), loss of consciousness ( p < 0.046), azathioprine consumption ( p < 0.004) during 1 month before ICU admission, mechanical ventilation ( p < 0.001), renal replacement therapy ( p < 0.001), CNS involvement ( p < 0.009), and ICU medications such as cyclosporine and azathioprine (0.03 and 0.03, respectively) or treatments such as plasmapheresis ( p < 0.018). Conclusion The ICU mortality rate of patients with SRD was high. Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases. Intensivists must keep in mind that SRD exacerbation may require immunosuppressive agents along with lifesaving interventions, more particularly in newly diagnosed SRDs. Key Points • The ICU mortality rate of patients with SRD was high. • Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases. • 63.8% of our patients fall into this category of new cases of rheumatologic disease and disease flare-up.

Atypical Presentation of Amyloidosis in a Female Patient with Muscle Weakness

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The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit

“…Previous studies have shown that shock, the use of vasopressors, the need for renal replacement, and mechanical ventilation are associated with poor prognosis [ 1 , 19 , 27 , 28 ]. In the current study, septic shock and the need for IMV were independent risk factors for mortality.…”

The correlation between red cell distribution width to albumin ratio and all-cause mortality in critically ill patients with rheumatic diseases: a population-based retrospective study

“…Patients with rheumatic diseases have a higher risk and mortality rate of admission to the intensive care unit (ICU) compared to the general population (1,2). The mortality rate of ICU population with rheumatic diseases has been reported to be 30.5-48% (3)(4)(5), which was greater than that of the common ICU patients (1,6). Thus, early identification for rheumatic patients at high risk of mortality is critical to improving prognosis and optimizing healthcare resource utilization.…”