Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Abstract

Background Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU. Results Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission. Conclusion Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

Caracterización y mortalidad de pacientes con enfermedades Reumatológica ingresados en una unidad de cuidados intensivos adultos del Paraguay

“…Varias publicaciones mencionan a las infecciones como causa principal de admisión a terapia intensiva 10,11,12 , en nuestro trabajo sin embargo las causas médicas que motivaron la internación a UCI fueron en primer lugar la insuficiencia respiratoria aguda, seguida del estado de shock, causas también mencionadas en este orden por el trabajo de Dumas et al 9 , y solo un 11% de nuestros pacientes presentaron infecciones documentadas como motivo de ingreso.…”

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

“…Furthermore, a French cohort study involving patients with SRDS demonstrated that infection and SRD exacerbation were the most common causes of ICU admission [ 20 ]. Godeau and Wang et al also reported that infection was the most frequent cause of ICU admission and mortality [ 21 , 22 ]. Barrett et al in 2017 reported higher rates of severe sepsis and poorer prognosis in SRD patients than in the general population [ 14 ].…”

“…Two previous studies have shown that the use of corticosteroids for the treatment of SRDs leads to a poorer prognosis as a result of short-term hospitalization in the ICU [ 22 , 27 ]. Patients with SRDs often have multiple comorbid conditions such as pulmonary dysfunction, renal dysfunction, and hypertension that can affect the prognosis of ICU admission [ 20 ].…”

Factors Affecting Patient Satisfaction Related to Cost and Treatment Effectiveness in Rheumatoid Arthritis: Results From the Multicenter Observational Cohort Study, FRANK Registry

“…As several reports have shown, disease activity in uences treatment effectiveness and patient satisfaction, while treatment cost is an independent factor of treatment satisfaction (10,12,13,38) 39), but continuous use of higher doses should be avoided due to risk of infection, osteoporosis, diabetes mellitus, thrombotic stroke, cardiovascular diseases, and death (40)(41)(42)(43). However, discontinuation of prednisolone has been achieved in only nearly half of 508 patients with early RA in recent study (39); the inability to taper prednisolone has been reported as one of the characteristics of di cult-to-treat RA (44).…”