Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis

Abstract

ObjectivesThe interest on autoimmune diseases (ADs) and their outcome at the intensive care unit (ICU) has increased due to the clinical challenge for diagnosis and management as well as for prognosis. The current work presents a-year experience on these topics in a tertiary hospital.MethodsThe mixed-cluster methodology based on multivariate descriptive methods such as principal component analysis and multiple correspondence analyses was performed to summarize sets of related variables with strong associations and common clinical context.ResultsFifty adult patients with ADs with a mean age of 46.7±17.55 years were assessed. The two most common diagnoses were systemic lupus erythematosus and systemic sclerosis, registered in 45% and 20% of patients, respectively. The main causes of admission to ICU were infection and AD flare up, observed in 36% and 24%, respectively. Mortality during ICU stay was 24%. The length of hospital stay before ICU admission, shock, vasopressors, mechanical ventilation, abdominal sepsis, Glasgow score and plasmapheresis were all factors associated with mortality. Two new clinical clusters variables (NCVs) were defined: Time ICU and ICU Support Profile, which were associated with survivor and no survivor variables.ConclusionsIdentification of single factors and groups of factors from NCVs will allow implementation of early and aggressive therapies in patients with ADs at the ICU in order to avoid fatal outcomes

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

“…Despite the young age of the patients, it was found a high rate of comorbidities, especially high blood pressure, which was present in 42% and renal failure with 18%, these being unusual in such a high proportion in this age group and making more difficult the management of these patients [3,8]. Interestingly, patients entered with high levels of disease activity (SLEDAI 20) but with an APACHE median score of 13, which is low Table 6 Therapeutic management during the stay in the ICU Therapeutic treatment N = 45 n(%)…”

“…• Ceftriaxone 7 (15,5) • Ampicillin sulbactam 5 (11,1) • Anti MRSA does not vancomycin * 5 (11,1) • Ciprofloxacin 4 (8,9) • Tuberculosis treatment 3 (6,7)…”

“…o Acute Pulmonary Edema 8 (17,8) o ARDS a 5 (11,1) o Pleural effusion 4 (8,9) o Alveolar hemorrhage 4 (8,9) o Pneumonitis 3 (6,7)…”

“…At the local level, few studies provide information on patients with SLE and admission to the ICU, and those that do exist to RD in general [2,[6][7][8][9]. It is therefore essential to have data of SLE in Latin America since certain factors vary with a geographic location such as race and access to health services that can significantly affect the prognosis of this disease [10,11].…”

Acute Respiratory Events in Connective Tissue Disorders

“…Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in the ambit of almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure - in most cases requiring ventilatory support - as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event [1,2,3,4,5,6,7,8,9,10]. …”