Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients

Shi, Yan; Du, Bin; Qin, Hanyu; Hu, Xiaoyun; Jiang, Wei; Wang, Chun-Yao; Weng, Li; Wang, Qian; Zeng, Xiaofeng; Jiang, Peng

doi:10.1007/s10067-020-05080-w

Cited by 5 publications

(8 citation statements)

References 34 publications

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“…ARF, as seen in this study, is a significant cause of morbidity and mortality in patients with SRDs. Many structures in the respiratory system, particularly the pleura, airway, alveoli, lung parenchyma, and vascular structures in the lung, can be affected by SRDs, resulting in organ involvement [ 1 , 17 ]. ARF may be the cause of the disease’s first clinical manifestation and even the reason for admission to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with lung involvement who use immunosuppressive or biological agents concurrently are more vulnerable to respiratory tract infections. Shi et al investigated the etiology and outcome of SRD patients admitted to the ICU due to ARF [ 17 ]. SLE was reported to be the most common diagnosis, infection and flare-up of the primary disease were the most common causes of ARF, and mortality was high.…”

Section: Discussionmentioning

confidence: 99%

“…Organ involvement that existed prior to hospitalization and organ involvement that resulted in hospitalization in the ICU were classified separately as respiratory, kidney, neurological, cardiovascular, gastrointestinal, hematological system, and other [ 17 ]. Acute kidney injury (AKI) was diagnosed according to Kidney Disease: Improving Global Outcomes (KDIGO) 2012 criteria [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

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

AYDIN,

TÜRK

2023

Turkish Journal of Medical Sciences

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Background/aim Immunosuppressive and immunomodulatory treatments developed in recent years as a result of a better understanding of the pathophysiology of systemic rheumatic diseases (SRDs) improve the prognosis. Despite medical advances, individuals with SRDs at any stage may require intensive care and have a high mortality rate. The aim of this study was to investigate the demographic and clinical characteristics of patients with rheumatic diseases admitted to the intensive care unit (ICU), and the factors associated with the risk of mortality. Materials and methods This was a retrospective, cross-sectional study that included patients with rheumatic diseases in the medical ICU. Factors of ICU 28-day mortality were identified by multiple-variable logistic analysis. Results A total of 127 patients with SRDs admitted to the medical ICU were enrolled. Systemic lupus erythematosus (SLE) (32.3%) was the most common diagnosis of SRDs in patients admitted to the ICU. The reasons for admission to the ICU were combined infection and primary SRD flare-up (35.4%), primary SRD flare-up (22%), SRD-unrelated reasons (22%), infection (17.3%), drug side effects (3.9%), and SRD-related complications (0.8%). The most common organ dysfunctions before (49.6%) and during (77.2%) admission to ICU were in the respiratory system. The 28-day mortality was 78 (61.4%). While the maximum procalcitonin, serum lactate, and blood urea nitrogen (BUN) levels were higher in the nonsurvivor group, the platelet and serum albumin levels were statistically significantly lower than those in the survivor group (p < 0.05). Acute respiratory failure (ARF), the presence of septic shock, the need for invasive mechanical ventilation (IMV), BUN level, and low platelet-lymphocyte ratio (PLR) were significant in the final multiple-variable model. Conclusion Significant predictors of mortality in patients with rheumatic diseases may include ARF, septic shock, the need for IMV, and high BUN and low PLR levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

AYDIN,

TÜRK

2023

Turkish Journal of Medical Sciences

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“…Respiratory failure, probably resulting from diffuse alveolar hemorrhage or pulmonary fibrosis accompanied with severe pneumonia, was another independent risk factor of in-ICU death. In a study that focused on the outcome of rheumatology patients with acute respiratory failure, the in-ICU mortality rate was high (59.8%), and vasculitis was associated with increased mortality ( 49 ). Ozdemir et al showed in their study that 5 (25.0%) patients died of respiratory failure, with massive hemoptysis (four patients) and resistant pulmonary edema (one patient) ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Critically Ill Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

et al. 2021

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Background: Patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) may require intensive care unit (ICU) admission due to different reasons, and the in-ICU mortality is high among AAV patients. The aim of this study was to explore the clinical features and risk factors of mortality of patients with AAV in the ICU.Methods: A retrospective study was conducted based on 83 AAV patients admitted to the ICU in a tertiary medical institution in China. Data on clinical characteristics, laboratory tests, treatment in ICU and outcomes were collected. The data were analyzed using univariate and multivariate logistic regression analysis to explore the variables that were independently related to mortality. Kaplan–Meier method was used to assess the long-term survival.Results: Among the 83 patients, 41 (49.4%) were female. The mean age of patients was 66 ± 13 years. Forty-four patients deceased, with the in-ICU mortality of 53%. The most common cause for ICU admission was active vasculitis (40/83, 48.2%). The main cause of death was infection (27/44, 61.4%) followed by active vasculitis (15/44, 34.1%). A multivariate analysis revealed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) at ICU admission (OR = 1.333, 95% CI: 1.031–1.722) and respiratory failure (OR = 620.452, 95% CI: 11.495–33490.306) were independent risk factors of in-ICU death. However, hemoglobin (OR = 0.919, 95% CI: 0.849–0.995) was an independent protective factor. The nomogram established in this study was practical in predicting the risk of in-ICU mortality for AAV patients. Moreover, for 39 patients survived to the ICU stay, the cumulative survival rates at 0.5, 1, and 5 years were 58.3%, 54.2%, and 33.9%, respectively, and the median survival time was 14 months.Conclusion: In our study, active vasculitis was the most frequent reason for ICU admission, and the main cause of death was infection. APACHE II and respiratory failure were independent risk factors while hemoglobin was an independent protective factor of in-ICU mortality for AAV patients admitted to the ICU. The risk prediction model developed in this study may be a useful tool for clinicians in early recognition of high-risk patients and applying appropriate management.

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“…[9], используя национальную базу данных Англии, сообщили о том, что ежегодное число случаев ППн увеличилось со 157 в 2000 г. до 352 в 2010 г. При этом случаи ППн участились у пациентов без ВИЧ, особенно -у тех, кто перенёс трансплантацию, у больных гематологическими и злокачественными новообразованиями (ЗНО), а также у больных РЗ [9]. По данным ретроспективного моноцентрового исследования, из всего пула пациентов с РЗ, поступивших в стационар с признаками острой дыхательной недостаточности, у 39,8% диагностирована ППн [10]. Авторы [11] представили наблюдение 6 случаев ППн у пациентов с РЗ (5 больных системными васкулитами (СВ) и один -РА) за годичный период.…”

Section: распространённость ппнunclassified

Pneumocystis Pneumonia in Rheumatic Diseases: Prevention Issues

Гриднева

Белов

Аронова

2022

A&Ch

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The incidence of pneumocystis pneumonia (PCP) in patients with rheumatic diseases (RD) continues to increase. This is facilitated by the increasing use of genetically engineered biological agents in addition to the use of cytostatics and glucocorticoids. Mortality due to PCP among patients with RD is extremely high, so the issues of its prevention are relevant. European and American scientists focus on the frequency of detection of PCP and the determination of the proportionality of certain risk factors, while the recommendations for prevention are formulated cautiously. Asian medical communities are unanimous in their opinion about the need to prevent PCP, only the dosage of drugs and the duration of the course of treatment are discussed.

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Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients

Cited by 5 publications

References 34 publications

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

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

Predictors of Mortality in Critically Ill Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Pneumocystis Pneumonia in Rheumatic Diseases: Prevention Issues

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