Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

Abstract

Introduction/Background: Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. Methods: The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. Results: The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). Conclusions: Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.

Sepsis Mortality Is high in Patients With Connective Tissue Diseases Admitted to the Intensive Care Unit (ICU)

“…SOFA score has been shown to be associated with mortality in patients with systemic vasculitis as well as rheumatoid arthritis before. 34,35,[42][43][44] Contrary to our results, the study of Zamir et al found the APACHE II score to be a stronger predictor of mortality (AUC 0.82). 40 The determined cut off values for each score (see Figure 1 for details) might be helpful for clinical decisions in septic patients with CTDs.…”

“…Of interest, mortality is slightly lower than in RA 34 as well as systemic vasculitis patients. 35 A literature search for patients with CTDs and admission to ICU mostly showed mixed cohorts (i.e. different rheumatic diseases including CTDs, rheumatoid arthritis and Spondylarthritis) and heterogenic reasons for ICU admission.…”

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis

“…16 Several scoring systems and clinical biomarkers have been leveraged for the prognostic evaluation of sepsis patients, but owing to the complex nature of this condition, no specific clinical indicator has been reliably shown to predict outcomes in this patient population. 17 While the SOFA and APACHE II scores have been employed to estimate sepsis patient mortality in a clinical setting, with higher scores being positively correlated with higher rates of mortality, [18][19][20] these scoring systems are time-consuming, complex, and tedious, limiting their more widespread utilization.…”

“…In sum, 801 sepsis cases participated in this survey (mean age: 57.37±17.73 years old; 64.4% male). These patients exhibited respective median SOFA and APACHE II scores of 5 (IQR 3-8) and [15][16][17][18][19][20]. Of these cases, 722 (90.14%) survived for 7 days, while 79 (9.86%) died during this period.…”