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

Abstract

Objectives: Patients with connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE) have an increased risk for infections. This study investigated the outcome and characteristics of CTD patients under intensive care unit (ICU) treatment for sepsis. Methods: A single-center retrospective analysis was conducted and reviewed all patients with a CTD diagnosis admitted to the ICU of a university hospital for sepsis between 2006 and 2019. Mortality was computed and multivariate logistic regression was used to detect independent risk factors for sepsis mortality. Furthermore, the positive predictive value of ICU scores such as Sequential Organ Failure Assessment (SOFA) score was evaluated. Results: This study included 44 patients with CTD (mean age 59.8 ± 16.1 years, 68.2% females), most of them with a diagnosed SLE (61.4%) followed by systemic sclerosis (15.9%). 56.8% (n = 25) were treated with immunosuppressives and 81.8% (n = 36) received glucocorticoids. Rituximab was used in 3 patients (6.8%). The hospital mortality of septic CTD patients was high with 40.9%. It was highest among systemic sclerosis (SSc) patients (85.7%). SOFA score and diagnosis of SSc were independently associated with mortality in multivariate logistic regression ( P = 0.004 and 0.03, respectively). The Simplified Acute Physiology Score II (SAPS II), SOFA and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were good predictors of sepsis mortality in the investigated cohort (SAPS II AUC 0.772, P = 0.002; SOFA AUC 0.756, P = 0.004; APACHE II AUC 0.741, P = 0.007). Conclusions: In-hospital sepsis mortality is high in CTD patients. SSc diagnoses and SOFA were independently associated with mortality. Additionally, common ICU scores were good predictors for mortality.

Prognostic impacts of repeated sepsis in intensive care unit on autoimmune disease patients: a retrospective cohort study

“…Moreover, within the repeated group, scores of the tools were higher during the last ICU stays in the comparison between the first admissions and the last ones (all P < 0.05), suggesting that sepsis developing repeatedly were more severely ill than those occurred at the first time. These findings are partly similar to other published literature reporting a correlation between Max SOFA, CCI, and SAPS-II scores and ADs [ 5 , 29 – 31 ]. To summarize, the higher scores of three quantified assessment tools were long-term mortality-associated risk factors for AD patients whether with recurrent sepsis episodes or with single one.…”

“…Whereas, these studies on repeated sepsis rarely involved AD population. Other studies on ADs found that sepsis was an important factor influencing the mortality of ADs patients [ 5 , 20 ], but they did not give a specific definition of whether the sepsis they studied was new-onset or recurrent. These studies provided some clues of the impact of sepsis on ADs, and our findings regarding the long-term prognosis of ADs in relation to recurrent sepsis helps made up for the limitations of these studies.…”

“…In the USA, severe sepsis is reported to occupy about 10% of all admissions to intensive care units (ICU) and its mortality highly reaches 30% [ 3 ]. Moreover, the coexistence between AD and sepsis is common in hospitalization, and the mortality of sepsis overlapping with ADs in ICU is up to 40% [ 1 , 4 , 5 ]. Owing to the high prevalence and high mortality of ADs with sepsis, improving health outcomes among this population has become a notable research focus.…”

What are the independent parameters associated with increased mortality risk in patients with severe sepsis or septic shock in the intensive care unit?

“…SAPS II scores were also observed to be higher among non-survivors in all three assessments, but statistical significance was not reached for the comparison of admission scores between the groups. In a study examining the mortality characteristics of sepsis patients hospitalized in the intensive care unit, Krasselt et al suggested that -similar to our study-SOFA, SAPS II and APACHE II scores could be used to predict mortality [4]. Haas et al reported that these 3 scales were successful in predicting mortality in sepsis, but, interestingly, quick SOFA (qSOFA) had better results than SOFA, SAPS II and APACHE II [5].…”

“…Different scoring systems have been used for the assessment of sepsis severity, prediction of mortality and morbidity, and determination of prognosis in the intensive care unit. Researchers have examined the utility of these scores and additional parameters in predicting mortality among patients with sepsis in many studies, which have resulted in the publication of various findings contributing to the guidelines of sepsis management [4][5][6][7][8][9][10][11]. In Turkey however, there are only a few studies examining outcomes associated with the clinical practice of the international guidelines for the management of severe sepsis and septic shock.…”