Evaluation of clinical features and prognostic factors in critically ill patients with rheumatic diseases
CCCF ePoster library. Poddar B. 11/13/19; 283384; EP127
Dr. Banani Poddar
Dr. Banani Poddar
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Sundarsingh Vijay1, Misra R N 2, Baronia A K 1

Departments of Critical Care Medicine and Clinical Immunology , Sanjay  Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India - 226014


Introduction
Rheumatic diseases (RD) affect multiple systems and hence predispose the patients to develop organ failures, often requiring ICU admission.
Objectives

Evaluation of the following in critically ill patients with RD admitted to ICU,

  1. Demographic factors, indications and severity of illness scores at the time of ICU admission
  2. Organ supports required in  ICU
  3. Factors affecting outcome
Materials and methods
Setting: Mixed ICU of tertiary care teaching institute.
Patients: All patients with RD admitted to ICU from August 2003 till March 2016.
Retrospective study with retrieval of information from electronic hospital information system, ICU flow sheets and discharge summaries .Demographic and clinical features including specific diseases of the patient before ICU admission was correlated with patient outcomes
.
Results
A total of 54 patients with RD were analysed, median age was 40 years (IQR: 29 - 49), 87% were female. The median APACHE II score was 19 (16-22.5) and SOFA score was 9 (7-10.5). 74% were in sepsis, commonest source being the lungs (85.7%). The commonest primary diagnosis was SLE (42.6%), followed by inflammatory myositis (20.3%).The causes for ICU admission were as follows: rheumatic disease flare-up in 12 patients (22.2%), infection in 36 patients (66.7%), infection and flare in 4 patients (7.4%) and acute serious illnesses unrelated to the rheumatic condition in 2 patients (3.7%).  Indication for admission was respiratory failure in  46 (85%) followed by circulatory shock in 43 patients (79.6%). 74% had 3 or more organ failuresForty nine patients (90.7%) required mechanical ventilation for a median of 8 days (3-14.75); 87% required vasopressors for a median of 3 (2-7) days. RRT was required in 21 (38.8%) patients. Therapy for underlying disease given during the ICU stay included steroids in 92%, pulse steroid in 29.6%, IVIg and plasmapheresis in 24%, and others  in 24%.
The median length of ICU stay was 10 days (4.75-19.5). 27 patients survived till ICU discharge. On univariate analysis, factors associated with death included older age (45 vs 35, p= 0.04; odds ratio [OR] 1.044, 95% CI 1.004-1.085), higher APACHE II score (22 vs 17.5, p=0.002; OR 1.22, 95% CI 1.06-1.4) and SOFA score (10 vs 8,    p<0.001; OR 1.99, 95% CI 1.31-3.03), while days free of vasopressors was associated with survival (12.5 vs 1, p=0.004, OR 0.89, 95% CI 0.81-0.96).
 SOFA score alone was associated with mortality on multivariate analysis. Area under the curve to predict outcome using APACHE II and SOFA scores was 0.76 and 0.86 respectively (p=0.002 and <0.001).
Conclusions
The most common RD requiring ICU admission is SLE and infection is the leading cause of ICU admission. Most patients have multi organ involvement. SOFA score is a good predictor of mortality, similar to non-RD patients. Younger patients and those requiring vasopressors for shorter duration have a better prognosis.


 
  1. Brünnler T, Susewind M, Hoffmann U, Rockmann F, Ehrenstein B, Fleck M. Outcomes and prognostic factors in patients with rheumatologic diseases admitted to the ICU. Intern Med 2015; 54:1981-7.
  2. Moreels M, Mélot C, Leeman M. Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive care Med 2005;31:591-3.
  3. Dumas G, Géri G, Montlahuc C, Chemam S, Dangers L, Pichereau C, et al. Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study. Chest 2015;148:927-35.
ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Sundarsingh Vijay1, Misra R N 2, Baronia A K 1

Departments of Critical Care Medicine and Clinical Immunology , Sanjay  Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India - 226014


Introduction
Rheumatic diseases (RD) affect multiple systems and hence predispose the patients to develop organ failures, often requiring ICU admission.
Objectives

Evaluation of the following in critically ill patients with RD admitted to ICU,

  1. Demographic factors, indications and severity of illness scores at the time of ICU admission
  2. Organ supports required in  ICU
  3. Factors affecting outcome
Materials and methods
Setting: Mixed ICU of tertiary care teaching institute.
Patients: All patients with RD admitted to ICU from August 2003 till March 2016.
Retrospective study with retrieval of information from electronic hospital information system, ICU flow sheets and discharge summaries .Demographic and clinical features including specific diseases of the patient before ICU admission was correlated with patient outcomes
.
Results
A total of 54 patients with RD were analysed, median age was 40 years (IQR: 29 - 49), 87% were female. The median APACHE II score was 19 (16-22.5) and SOFA score was 9 (7-10.5). 74% were in sepsis, commonest source being the lungs (85.7%). The commonest primary diagnosis was SLE (42.6%), followed by inflammatory myositis (20.3%).The causes for ICU admission were as follows: rheumatic disease flare-up in 12 patients (22.2%), infection in 36 patients (66.7%), infection and flare in 4 patients (7.4%) and acute serious illnesses unrelated to the rheumatic condition in 2 patients (3.7%).  Indication for admission was respiratory failure in  46 (85%) followed by circulatory shock in 43 patients (79.6%). 74% had 3 or more organ failuresForty nine patients (90.7%) required mechanical ventilation for a median of 8 days (3-14.75); 87% required vasopressors for a median of 3 (2-7) days. RRT was required in 21 (38.8%) patients. Therapy for underlying disease given during the ICU stay included steroids in 92%, pulse steroid in 29.6%, IVIg and plasmapheresis in 24%, and others  in 24%.
The median length of ICU stay was 10 days (4.75-19.5). 27 patients survived till ICU discharge. On univariate analysis, factors associated with death included older age (45 vs 35, p= 0.04; odds ratio [OR] 1.044, 95% CI 1.004-1.085), higher APACHE II score (22 vs 17.5, p=0.002; OR 1.22, 95% CI 1.06-1.4) and SOFA score (10 vs 8,    p<0.001; OR 1.99, 95% CI 1.31-3.03), while days free of vasopressors was associated with survival (12.5 vs 1, p=0.004, OR 0.89, 95% CI 0.81-0.96).
 SOFA score alone was associated with mortality on multivariate analysis. Area under the curve to predict outcome using APACHE II and SOFA scores was 0.76 and 0.86 respectively (p=0.002 and <0.001).
Conclusions
The most common RD requiring ICU admission is SLE and infection is the leading cause of ICU admission. Most patients have multi organ involvement. SOFA score is a good predictor of mortality, similar to non-RD patients. Younger patients and those requiring vasopressors for shorter duration have a better prognosis.


 
  1. Brünnler T, Susewind M, Hoffmann U, Rockmann F, Ehrenstein B, Fleck M. Outcomes and prognostic factors in patients with rheumatologic diseases admitted to the ICU. Intern Med 2015; 54:1981-7.
  2. Moreels M, Mélot C, Leeman M. Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive care Med 2005;31:591-3.
  3. Dumas G, Géri G, Montlahuc C, Chemam S, Dangers L, Pichereau C, et al. Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study. Chest 2015;148:927-35.
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