Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris.
Medical Intensive Care Unit, Cochin Teaching Hospital, Paris.
Chest. 2015 Oct;148(4):927-935. doi: 10.1378/chest.14-3098.
Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities.
This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis.
Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival.
In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
患有系统性风湿病（SRD）的患者可能需要重症监护病房（ICU）来治疗 SRD 恶化或与治疗相关的感染或毒性。
这是一项在法国 10 所大学附属医院进行的观察性研究。连续纳入患有 SRD 的患者。通过多变量逻辑分析确定 ICU 死亡率的决定因素。
共有 363 名（65.3%为女性；中位年龄 59 岁[四分位距，42-70 岁]）患者纳入 381 例次住院。结缔组织病（主要为系统性红斑狼疮）占 SRD 的 66.1%，系统性血管炎占 26.2%（主要为抗中性粒细胞胞质抗体相关性血管炎）。43 例（11.3%）为新发 SRD。直接入住 ICU 的有 143 例（37.9%）。入住 ICU 的原因包括感染（39.9%）、SRD 恶化（34.4%）、毒性（5.8%）或其他原因（19.9%）。呼吸受累是最主要的入住原因（56.8%），其次是休克（41.5%）和急性肾损伤（42.2%）。入住第 1 天的中位序贯器官衰竭评估（SOFA）评分为 5 分（3-8 分）。需要机械通气的占 57%，使用升压药的占 33.9%，需要肾脏替代治疗的占 28.1%。ICU 死亡率为 21.0%（80 例死亡）。与 ICU 死亡率相关的因素包括休克（OR，3.77；95%CI，1.93-7.36）、第 1 天的 SOFA 评分（OR，1.19；95%CI，1.10-1.30）和直接入住（OR，0.52；95%CI，0.28-0.97）。合并症和 SRD 特征均与生存无关。
在患有 SRD 的患者中，只有先前已知的 SRD 患者才需要进行重症监护治疗；然而，12%的患者可能在 ICU 中确诊。这些情况中感染和 SRD 恶化超过三分之二，主要针对肺部。直接入住 ICU 可能改善结局。
