Abstract
BackgroundDiffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening. The objective was to assess characteristics and prognosis factors of DAH who required intensive care unit (ICU) admission in patients with autoimmune diseases.MethodsFrench multicenter retrospective study including patients presenting DAH related to autoimmune diseases requiring ICU admission from 2000 to 2016.ResultsOne hundred four patients (54% of men) with median age of 56 [32–68] years were included with 79 (76%) systemic vasculitis and 25 (24%) connective tissue disorders. All patients received steroids, and 72 (69%), 12 (11.5%), and 57 (55%) patients had cyclophosphamide, rituximab, and plasma exchanges, respectively. During ICU stay, 52 (50%), 36 (35%), and 55 (53%) patients required mechanical ventilation, vasopressor use, and renal replacement therapy, respectively. Factors associated with mechanical ventilation weaning were age (HR [95%CI] 0.97 [0.96–0.99] per 10 years, p < 0.0001), vasculitis-related DAH (0.52 [0.27–0.98], p = 0.04), and time from dyspnea onset to ICU admission (0.99 [0.99–1] per day, p = 0.03). ICU mortality was 15%. Factors associated with alive status at ICU discharge were chronic cardiac failure (HR [95%CI] 0.37 [0.15–0.94], p = 0.04), antiphospholipid syndrome-related DAH (3.17 [1.89–5.32], p < 0.0001), SAPS II (0.98 [0.97–0.99], p = 0.007), and oxygen flow at ICU admission (0.95 [0.91–0.99] per liter/min, p = 0.04).ConclusionDAH in autoimmune diseases is a life-threatening complication which requires mechanical ventilation in half of the cases admitted to ICU.
Highlights
Diffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening
Factors associated with mechanical ventilation weaning were age (HR [95%CI] 0.97 [0.96–0.99] per 10 years, p < 0.0001), vasculitis-related DAH (0.52 [0.27–0.98], p = 0.04), and time from dyspnea onset to intensive care unit (ICU) admission (0.99 [0.99–1] per day, p = 0.03)
Factors associated with alive status at ICU discharge were chronic cardiac failure (HR [95%CI] 0.37 [0.15–0.94], p = 0.04), antiphospholipid syndromerelated DAH (3.17 [1.89–5.32], p < 0.0001), SAPS Simplified Acute Physiology Score (II) (0.98 [0.97–0.99], p = 0.007), and oxygen flow at ICU admission (0.95 [0.91–0.99] per liter/min, p = 0.04)
Summary
Diffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening. The objective was to assess characteristics and prognosis factors of DAH who required intensive care unit (ICU) admission in patients with autoimmune diseases. Diffuse alveolar hemorrhage (DAH) is a form of pulmonary hemorrhage that originates from the pulmonary microcirculation [1]. Immune causes represent 30 to 40% of all DAH cases [3]. It can range from asymptomatic forms, diagnosed on systematic chest radiography, to life-threatening complications. Severe forms may lead to acute respiratory failure and require intensive care unit (ICU) management [4]. DAH represents 12% of ICU admissions in patients with an autoimmune disease [5]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have