Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit

Abstract

ObjectiveTo report the outcome of children with rheumatic diseases admitted to pediatric intensive care unit (PICU) in a tertiary hospital.MethodsDatabase from PICU and pediatric rheumatology section used to retrieve all candidate patients admitted to PICU from June 2000 to December 2017. Medical records of all enrolled patients reviewed for diagnosis, organ involvement, reason of PICU admission, the length of stay, and outcome.ResultsTwenty-five patients (17 female, 8 male) with total of 41 admissions identified. The median PICU stay was 13.5 days (range, 3–24). The most frequent diagnoses were systemic lupus erythematosus (SLE) (48%), followed by systemic vasculitis (16%). Most admissions were from the medical ward (68.3%), while 24.4% from the emergency room. The main reason of PICU admission was a disease flare or related complications (48.8%), followed by infection (34.2%). Fifty one percent of the admissions were due to respiratory dysfunction, 46% required non-invasive respiratory support while 38% was in need for mechanical ventilation. During PICU stay, anti-microbial agents used 90.3%, immunosuppressive treatment adjustment 75.6%, anti-hypertensive 24.4% and vasopressors 12.2%. Twelve patients (48%) fully recovered and 40% partially recovered while three patients died during their PICU stay. The causes of death were macrophage activation syndrome complicated by sepsis in two patients and advanced pulmonary hypertension in one patient.ConclusionOur data showed that children with rheumatic diseases, particularly SLE, are mostly admitted to PICU with serious disease exacerbation or severe infection. To improve the outcome, early diagnosis of critical condition and proper intervention are fundamental in reducing mortality.

Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America

“…However, the ICU length of stay in our cohort was lower than that reported by Al-Mayouf et al , where the median ICU stay was 13.5 (days). 30 Both the lower length of ICU stay in our cohort and the low mortality rate may be explained by early admission to the ICU and the timely treatment established in the PICU. Early vasopressor use has been associated with a reduction in all-cause mortality in other studies, 38 and its early use is recommended to reduce hypotensive time.…”

“…In total, 65% of patients admitted to the ICU had SLE in the cohort of Radhakrishna et al, 29 and in a Saudi Arabian cohort evaluating different outcomes in the pediatric population with AIDs over a 17-year period, SLE was present in 52% of patients, followed by systemic vasculitis in 16%. 30…”

“…However, the main cause of death was secondary to septic shock in patients with macrophage activation syndrome. 30…”

“…In total, 65% of patients admitted to the ICU had SLE in the cohort of Radhakrishna et al, 29 and in a Saudi Arabian cohort evaluating different outcomes in the pediatric population with AIDs over a 17-year period, SLE was present in 52% of patients, followed by systemic vasculitis in 16%. 30 The PRISM III score is one of the primary mortality prediction models used in pediatric ICUs. It encompasses 17 physiologic variables that include the worst value from the first 24 hours of the patient's ICU stay.…”

“…However, the main cause of death was secondary to septic shock in patients with macrophage activation syndrome. 30 Half (6, 50%) of the nonsurvivors died secondary to diffuse alveolar hemorrhage (DAH). DAH is a syndrome associated with high mortality rates and is a life-threatening emergency in clinical practice.…”