Systemic lupus erythematosus in the intensive care unit: a systematic review

Suárez-Avellaneda, Ana; Quintana, Jhon H; Aragón, Cristian C.; Gallego, Linda M; Gallego, Cindy-Natalia; Bolaños, J; Guerra, M; Ochoa, Minerva Lazos; Granados, Marcela; Ruiz-Ordóñez, Ingrid; Tobón, Gabriel J.

doi:10.1177/0961203320941941

Cited by 18 publications

(17 citation statements)

References 93 publications

(193 reference statements)

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“…Our study's mortality rate was even lower than those shown in some adult cohorts, where mortality rates varied from 18 to 78.5%. 34 However, the causes of mortality differed from ours. Only 11% of all deaths were attributed to AID activity in comparison to more than 80% of our deaths explained by this variable.…”

Section: Discussioncontrasting

confidence: 66%

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

Erazo-Martínez

Ruiz-Ordóñez

Álvarez

et al. 2022

J Pediatr Intensive Care

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Most autoimmune diseases (AIDs) during childhood debut with more severe and aggressive forms, with life-threatening conditions that increase the need for intensive care therapy. This study describes the clinical, laboratory, and health outcome features of pediatric patients with AIDs admitted to the pediatric intensive care unit (PICU). This is a retrospective cross-sectional study that included the clinical records of all pediatric patients with AIDs admitted to the PICU between 2011 and 2020 in Cali, Colombia. In total, 225 PICU admissions from 136 patients were evaluated. Median age was 13 (11–15) years, and the median disease duration was 15 (5–38.5) months. Systemic lupus erythematosus was the most prevalent disease (91, 66.9%), followed by vasculitis (27, 19.8%). The leading cause of PICU admission was AID activity (95, 44.3%). C-reactive-protein levels were associated with infections (p <0.0394). Mortality occurred in 12 (8.8%) patients secondary to AID activity, primarily, diffuse alveolar hemorrhage (6, 50%). A longer disease duration was associated with mortality (p <0.00398). AID activity was the leading cause of PICU admission and mortality. Pulse steroid therapy, mechanical ventilation, and inotropic and vasopressor support were associated with nonsurvival.

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Section: Discussioncontrasting

confidence: 66%

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

Erazo-Martínez

Ruiz-Ordóñez

Álvarez

et al. 2022

J Pediatr Intensive Care

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“…These results reinforce previous findings that lupus patients with episodes of bacteremia have poor outcome. 16 According to previous studies, the most common cause of ICU admission for patients with SLE was infection, [17][18][19] and those who were admitted to ICU due to infection had showed substantially longer ICU stay, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and higher mortality compared with SLE with noninfectious causes. 20 Considering its deteriorating effect on treatment outcomes and prognosis of SLE, identifying risk factors for BSI during immunosuppressive treatment is essential to establish an appropriate surveillance and prophylaxis strategy against BSI in patients with SLE receiving mediumto-high dose glucocorticoid treatment.…”

Section: Discussionmentioning

confidence: 99%

Risk of Bloodstream Infection in Patients with Systemic Lupus Erythematosus Exposed to Prolonged Medium-to-High-Dose Glucocorticoids

Kim

Choi

Park

et al. 2023

Lupus

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Objectives This study aimed to investigate the incidence rate and risk factors of bloodstream infection (BSI) in patients with systemic lupus erythematosus (SLE) exposed to medium to high doses of glucocorticoids. Methods This study included 1109 treatment episodes with prolonged (≥4 weeks) medium-to-high-dose glucocorticoids (≥15 mg/day prednisolone) in 612 patients with SLE for over 14 years. Clinical features regarding systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K), immunosuppressant use, and laboratory results were obtained from the electronic medical database. The primary outcome of this study was the 1-year incidence of BSI. The effect of clinical factors on the outcome was investigated using a generalized estimating equation. Results During a total of 1078.64 person-years, 30 cases of BSI occurred, with an incidence rate of 2.78 (95% confidence interval (CI) 1.88–3.97) per 100 person-years. Mortality rate of the treatment episodes with BSI was 16.7%, which was significantly higher than that in the other episodes (incidence rate ratio (IRR) 19.59, 95% CI 7.33–52.44). When the incidence rate of BSI was stratified by baseline glucocorticoid dose and SLEDAI-2K score, a higher incidence rate of BSI occurred as disease activity or baseline glucocorticoid dose increased. In the multivariable analysis, SLEDAI-2K ≥20 (adjusted IRR (aIRR) 4.66, 95% CI 2.17–10.00), initial baseline prednisolone ≥ 60 mg/day (aIRR 2.42, 95% CI 1.11–5.32), and cumulative prednisolone dose ≥15 mg/day during the previous 6 months (aIRR 2.13, 95% CI 1.03–4.40) significantly increased the risk of BSI. Conclusion In patients with SLE exposed to prolonged medium-to-high-dose glucocorticoids, the 1-year incidence rate of BSI was significantly higher than previously reported in the general patients with SLE. Severe disease activity, and high-dose glucocorticoid treatment previously or at baseline increased the risk of BSI.

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“…What are the recommendations for management of infection? [40][41][42][43][44][45] Mean rate ± SD: 8.81 ± 0.39, % of agreement: 100%, LOE: H…”

Section: Pulmonary Hemorrhagementioning

confidence: 99%

Egyptian recommendations for the management of systemic lupus erythematosus: a consensus, evidence-based, clinical practice guidelines for treat-to-target management

Miedany

El-Hadidi

Mahmoud

et al. 2023

Egypt Rheumatol Rehabil

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Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by having varying clinical presentation, severity, unpredictable course as well as outcomes. Recent disease-modifying conventional and biologic agents have enhanced rates of attaining both short- and long-term management goals, including minimization of glucocorticoid dose and use. This study was carried out to develop an up-to-date evidence-based, consensus on clinical practice guidelines for treat-to-target management of systemic lupus erythematosus in adults. Results The response rate to the online questionnaires, sent to the expert panel who participated in the three rounds, was 95.5%. At the end of round 3, a total of 14 recommendation sections were proposed for the T2T management of patients with SLE. Agreement with the recommendations (rank 7–9) ranged from 90.9–100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the proposed statements. Conclusion These recommendations provide a consensus on the treat-to-target management of patients with SLE. They provide strategies to reach optimal outcomes in common clinical scenarios, based on a combination of evidence and expert opinion.

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Systemic lupus erythematosus in the intensive care unit: a systematic review

Cited by 18 publications

References 93 publications

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

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

Risk of Bloodstream Infection in Patients with Systemic Lupus Erythematosus Exposed to Prolonged Medium-to-High-Dose Glucocorticoids

Egyptian recommendations for the management of systemic lupus erythematosus: a consensus, evidence-based, clinical practice guidelines for treat-to-target management

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