Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Toshifumi Fujiwara,Hidetoshi Tsushima,Tomohiko Akahoshi,Noriyuki Kaku,Tomoaki Taguchi,Kenta Momii,Kyohei Shiomoto,Kentaro Tokuda,Jun-Ichi Fukushi,Jun Maki,Yasuharu Nakashima,Yukio Akasaki,Satoshi Ikemura

doi:10.1186/s41927-020-00164-1

Abstract

BackgroundPatients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs).MethodsThis was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.ResultsUpon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.ConclusionOur study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

Highlights

Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs)
A previous study reported that the reasons for the ICU admission of RA patients included Cardiovascular disease (CVD) and serious infection and showed that RA patients have increased one-year mortality compared with the general population [8]
We elucidated that the prognostic factors of mortality for RA patients admitted to ICU included the use of csDMARDs, elevated updated Charlson’s comorbidity index (CCI), high acute physiology and chronic health evaluation (APACHE) II score, and prolonged prothrombin time international normalized ratio (PT-INR) at ICU admission

Summary

Introduction

Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Worsening comorbidities and complications in RA patients require advanced therapy, leading to admission into intensive care units (ICUs) [6,7,8,9]. Considering that patients with systemic rheumatic disease (RD) frequently require ICU treatment for their condition, it is important to understand the prognostic factors [16]. A recent study of 43 RA patients admitted to the ICU reported that the risk factors for 30-day mortality included heart failure, liver failure, elevated sequential organ failure assessment (SOFA) score, and vasopressor treatment [17]

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Discussion

Conclusion