Value of prognostic scores in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey

Abstract

Background/aim: There is a need for a scoring system for predicting ICU prognosis of patients with ANCA-associated vasculitis (AAV), but there are limited data on it in the literature. Therefore, we aimed to determine the scores that can estimate the prognosis of patients with AAV during intensive care follow up. Materials and methods: All adult patients admitted to the medical ICUs of 4 reference university hospitals in Turkey due to AAV activation and/or disease/treatment complications in the last 10 years were included in this study. Demographic data, treatments before ICU, the Birmingham Vasculitis Activity Score (BVAS) score at the time of vasculitis diagnosis, and BVAS, APACHE II, SOFA, and SAPS II scores at the ICU admission, treatments, procedures, and complications during ICU stay were recorded for all AAV patients. Results: Thirty-four patients were included in the study. The median age of the patients was 60 (42-70) years, and 64.7% were male. Twenty-five patients were diagnosed with Granulomatosis with polyangiitis, and 9 were diagnosed with Microscopic polyangiitis. The most common ICU admission causes were hemorrhage (85.3%) and sepsis/septic shock (67.6%). Twenty patients (58.8%) died in the ICU follow up. There were significant differences in APACHE II (P = 0.004) and SAPS II (P = 0.044) scores between survivors and nonsurvivors, while there were no significant differences in BVAS (during diagnosis P = 0.089 and ICU admission P = 0.539) and SOFA (P = 0.097) scores. APACHE II score was found to be an independent risk factor for ICU mortality (OR = 1.231, CI 95% = 1.011-1.498, P = 0.038) according to logistic regression analysis. An APACHE II score of greater than 20.5 predicted ICU mortality with 80% sensitivity and 70% specificity (AUC = 0.8, P = 0.004, Likelihood ratio = 2.6) according to the ROC curve analysis. Conclusion: APACHE II score can be used for the prediction of ICU mortality in AAV patients.

Predictors of Mortality in Critically Ill Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

“…In a study that focused on the outcome of rheumatology patients with acute respiratory failure, the in-ICU mortality rate was high (59.8%), and vasculitis was associated with increased mortality (49). Ozdemir et al showed in their study that 5 (25.0%) patients died of respiratory failure, with massive hemoptysis (four patients) and resistant pulmonary edema (one patient) (11). Demiselle et al reported that in-ICU death of five patients (33.0%) was attributed to multiple organ failure likely due to sepsis (12).…”

“…However, some AAV patients may require intensive care unit (ICU) admission due to life-threatening manifestations at the time of diagnosis, disease flare-up or severe complications due to immunosuppressive therapies (6)(7)(8). AAV is one of the most frequent systemic rheumatic diseases (SRD) in the ICU (9,10) with high mortality ranging from 15.5% to 58.8% (8,11,12). According to researches, the in-ICU mortality is higher among AAV patients compared with other SRD patients (13).…”

“…The number of studies on the clinical features and ICU outcome of AAV patients is limited. Previous studies have reported that infection and life-threatening manifestations of active vasculitis are the main reasons for ICU admission of AAV patients ( 8 , 11 ). The prediction of patients' outcome is clinically important, especially for patients in the ICU.…”

“…Different methods for measuring disease severity in ICU patients have been developed, including Acute Physiology and Chronic Health Evaluation II (APACHE II) ( 14 ), Sequential Organ Failure Assessment (SOFA) ( 15 ) and Simplified Acute Physiologic Score II (SAPS II) ( 16 ). These disease severity scores are computed at the time of admission to ICU and have been reported to be associated with ICU outcome of AAV patients in some studies ( 8 , 11 ). However, the value of specific vasculitis score like Birmingham vasculitis activity score system (BVAS) on patients' outcome in the ICU is yet to be shown ( 6 , 17 ).…”

Development of a Novel Simple Model to Predict Mortality in Patients With Systemic Lupus Erythematosus Admitted to the Intensive Care Unit

“…Besides, this may partly be limited to the level of medical treatment in our center. Importantly, patients with other systemic autoimmune disease such as antineutrophil cytoplasmic antibody (ANCA) associated vasculitis may sometimes require admission to the ICU due to life threatening conditions (31)(32)(33)(34)(35). Compared with patients with SLE, patients with ANCA-associated vasculitis in the ICU were older, with a median age of more than 60 years, and were more common in male.…”