Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database.

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Inflammatory response is a natural protective response in infection or injury. The immune imbalance of rheumatoid arthritis (RA) patients and the use of anti-rheumatic immune drugs may affect the inflammatory response process of shock. The evidence of the impact of RA on short-time mortality in shock patients is limited. This study was a retrospective observational study from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Patients diagnosed with shock were selected from the database. The primary outcome was in-hospital mortality. Binary logistic regression analysis was used to explore the association between RA and in-hospital mortality. Subgroup analysis of the association between in-hospital mortality and RA was performed in septic shock, cardiogenic shock, and other types of shock. A total of 8233 ICU patients with shock were identified. After adjusting for confounding variables, RA was associated with a lower risk of in-hospital mortality (OR, 0.58; 95% CI, 0.38-0.91). The results of the subgroup analysis showed that RA was associated with a decreased risk of in-hospital death in the septic shock group but not in cardiogenic shock or other types of shock. RA was associated with a lower risk of in-hospital death in shock patients. This association was only observed in septic shock but not in cardiogenic shock and other types of shock. Key Points •Rheumatoid arthritis (RA) is associated with a lower risk of in-hospital mortality in ICU patients with shock, particularly in those with septic shock. •This study utilized propensity score matching to accurately compare outcomes between RA and non-RA shock patients, ensuring balanced baseline characteristics. •Findings suggest that the immune modulation inherent to RA or the impact of anti-rheumatic drugs might influence the survival outcomes in shock scenarios. •The protective effect of RA on in-hospital mortality was not observed in patients with cardiogenic shock or other types of shock, indicating a specific interaction in septic shock contexts.