Frausova Doubravka, Brejnikova Martina, Hruskova Zdenka, Rihova Zuzana, Tesar Vladimir
Department of Nephrology, General Teaching Hospital and First Faculty of Medicine, Charles University in Prague, Czech Republic.
Ren Fail. 2008;30(9):890-5. doi: 10.1080/08860220802353892.
The natural course of as-yet-untreated ANCA-associated vasculitis (AAV) or complications of immunosuppressive treatment may result in rapid clinical deterioration with the need of admission to an intensive care unit (ICU). The aim of this retrospective study was to assess the outcome of patients with renal AAV admitted to the ICU in a single center. We reviewed the medical records of all 218 patients with AAV followed in our department between January 2001 and December 2006 and selected those admitted to the ICU. To assess the severity of critical illness, the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) score on the first ICU day were calculated. Birmingham Vasculitis Activity Score (BVAS) was calculated to represent the total disease activity. Thirty patients with AAV (11 women, 19 men; mean age 61.5 +/- 13.2 years; 20 x cANCA, 10 x pANCA positive) were included. The most common reasons for ICU admission were as follows: active vasculitis (13 patients, 43.3 %), infections (7 patients, 23.3%), and other causes (10 patients, 33.3%). The in-ICU mortality was 33.3% (10 patients). The most common cause of death was septic shock (in 5 patients). The APACHE II (33.5 vs. 23.8) and SOFA scores (11.9 vs. 6.6), but not BVAS (11.5 vs. 16.1), were statistically significantly higher in non-survivors than in survivors (p < 0.01). In conclusion, the in-ICU mortality in AAV patients may be predicted by APACHE II and SOFA scores. While active vasculitis is the most frequent reason for ICU admission, the mortality rate is highest in patients with infectious complications.
未经治疗的抗中性粒细胞胞浆抗体相关性血管炎（AAV）的自然病程或免疫抑制治疗的并发症可能导致临床快速恶化，需要入住重症监护病房（ICU）。这项回顾性研究的目的是评估在单一中心入住ICU的肾AAV患者的结局。我们回顾了2001年1月至2006年12月在我们科室随访的所有218例AAV患者的病历，并选择了入住ICU的患者。为了评估危重病的严重程度，计算了入住ICU第一天的急性生理与慢性健康状况评估（APACHE II）和序贯器官衰竭评估（SOFA）评分。计算伯明翰血管炎活动评分（BVAS）以代表疾病总活动度。纳入了30例AAV患者（11例女性，19例男性；平均年龄61.5±13.2岁；20例胞浆型抗中性粒细胞胞浆抗体阳性，10例核周型抗中性粒细胞胞浆抗体阳性）。入住ICU的最常见原因如下：活动性血管炎（13例患者，43.3%）、感染（7例患者，23.3%）和其他原因（10例患者，33.3%）。ICU内死亡率为33.3%（10例患者）。最常见的死亡原因是感染性休克（5例患者）。非幸存者的APACHE II评分（33.5对23.8）和SOFA评分（11.9对6.6），但BVAS评分（11.5对16.1）在统计学上显著高于幸存者（p<0.01）。总之，AAV患者的ICU内死亡率可通过APACHE II和SOFA评分预测。虽然活动性血管炎是入住ICU最常见的原因，但感染并发症患者的死亡率最高。
