Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

Maria Fernanda Alvarez Barreneche,Carlos Jaime Velasquez Franco,Miguel Antonio Mesa Navas,Libia Maria Rodriguez Padilla,William Dario Mcewen Tamayo,Daniel Montoya Roldan

doi:10.1186/s42358-019-0073-9

Maria Fernanda Alvarez Barreneche, Carlos Jaime Velasquez Franco + Show 4 more

Open Access

https://doi.org/10.1186/s42358-019-0073-9

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Abstract

ObjectiveDescribe the clinical and epidemiologic characteristics of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU).Methodsa retrospective study with medical records review of patients with systemic lupus erythematosus (SLE) admitted to the ICU between 2004 and 2015 were included. Qualitative variables were described using absolute and relative frequencies. For quantitative variables mean value and standard deviation (SD) or median value with the interquartile range (IQR) depending on data distribution. To compare groups, it was used the Student t-test or Mann Whitney U test as appropriate and Fisher’s exact test.Results33 patients were included, with a total of 45 ICU admissions, 29 (87.9%) were females with a median age of 26 years. The median time of diagnosis of SLE was two years, (IQR 1.5–5). The most common SLE manifestation and comorbidity were renal disease and hypertension with 27 (81.8%) and 14 (42.4%) respectively. The main reason for admittance was lupus flare with 25 events (55.5%). Infection was the second cause of admission with 19 events (42.2%). The median stay time in the ICU was four days (IQR 2–7). LODS score was 6 (RIQ 5–8), and APACHE II score was 13 (RIQ 11–17.7). There were 29 infections (64.5%) of which 20 (69%) were hospital-acquired. Four (12.1%) patients died.ConclusionUnlike most of the previously reported series, in this study SLE activity was the most common cause of admission in the ICU. A more aggressive disease and difficulties in the ambulatory setting could explain this behavior. Despite the higher percentage of lupus flares, there was lower mortality.

Highlights

Rheumatological diseases (RD) are a heterogeneous group of entities with a chronic course and multisystemic involvement associated with significant morbidity and mortality
This has led to less prevalent diseases such as systemic lupus erythematosus (SLE) occupy their place as a cause of admission to intensive care unit (ICU) within the RD [3,4,5], generating a knowledge gap, which is important given that the behavior of SLE differs significantly from other ERs
Baseline characteristics The median time of SLE diagnosis was two years (RIQ 1– 5.5 years), the most frequent clinical manifestation was renal involvement, in 27 patients (81.8%), followed by joint in 19 (57.6%)

Summary

Introduction

Rheumatological diseases (RD) are a heterogeneous group of entities with a chronic course and multisystemic involvement associated with significant morbidity and mortality. The complexity of the management of these diseases in the intensive care unit (ICU) lies in the fact that their complications do not derive only from the activity of RD, but from other associated factors such as the side effects of Historically, patients with rheumatoid arthritis (RA) have occupied the first place of RD admitted to the ICU [3]. This has changed in recent decades secondary to therapeutic advances that have allowed better control of the disease and less dependence on steroidal therapy and non-steroidal anti-inflammatory drugs (NSAIDs). The therapeutic advances in the different rheumatological diseases have not been the same, which accentuates the differences between them

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