Analysis of clinical features and prognostic factors in Chinese patients with rheumatic diseases in an intensive care unit

Abstract

Aim of the workTo describe the clinical features and prognostic factors in patients with rheumatic diseases (RDs) admitted to the intensive care unit (ICU). Patients and methodsClinical data of 33 RD patients admitted to the ICU of Shenzhen Baoan Hospital were retrospectively analyzed regarding the causes for admission, medications received, duration of stay and the management required. Disease severity of the patients was assessed using the acute physiology and chronic health evaluation (APACHE-II) score. ResultsThe diagnoses of the patients included 16 (48.5%) systemic lupus erythematosus (SLE), 7 (21.2%) systemic vasculitis, 4 (12.1%) rheumatoid arthritis; 3 (9.1%) polymyositis/dermatomyositis; 2 (6.1%) Sjögren’s syndrome and 1 (3%) with systemic sclerosis. The mean APACHE-II score was mean 16.1±7.3. The main cause for ICU admission was infection in 12 (36.4%) patients, primary disease worsening in 8 (24.2%), infection associated with disease activity in 9 (27.3%) and 4 (12.1%) cases were hospitalized for other disease processes (including 1 case of subarachnoid hemorrhage, 1 case of acute myocardial infarction and 2 with hypovolemic shock). 31 (93.9%) had more than one organ involved. Mortality was 51.5% (17 cases); including 9 (27.3%) deaths from infection, 5 (15.2%) from primary diseases, and 3 (9.1%) from other causes. Primary disease worsening and APACHE-II score were significantly increased in the mortality cases (33.3% and 20±7.1) compared to survivors (13.3% and 10±1.2) (p=0.017 and 0.0001 respectively). ConclusionSLE was the most frequent cause of ICU admission; infections are the leading causes prompting admission. RDs patients often had multi-organ involvement with a high mortality rate.