Guo Jinyan, Huang Zhen, Huang Maoxin, He Yujie, Han Bing, Ma Ning, Yu Zujiang, Liu Shengyun, Ren Zhigang
Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiovascular Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Med (Lausanne). 2021 Jul 22;8:689871. doi: 10.3389/fmed.2021.689871. eCollection 2021.
Patients with systemic lupus erythematosus (SLE) may sometimes require admission to the intensive care unit (ICU), and the outcome is poor. The aim of this study was to explore the clinical features of patients with SLE in the ICU, identify prognostic factors, and develop and evaluate a prognostic model to predict in-ICU mortality of patients with SLE. This was a single center retrospective study in a tertiary medical institution in China. A total of 480 SLE patients with 505 ICU admissions from 2010 to 2019 were screened, and 391 patients were enrolled. The clinical feature and outcomes of the patients were analyzed. According to the random number table, patients were divided into two mutually exclusively groups named derivation ( = 293) and validation ( = 98). Prognostic factors were identified by a Cox model with Markov Chain Monte Carlo simulation and evaluated by latent analysis. The risk score was developed based on the derivation group and evaluated using the validation group. Among the 391 patients, 348 (89.0%) patients were females. The median age of patients was 34 years, and the median course of SLE was 6 months. The median APACHE II and SLEDAI were 17 and 10, respectively. The average in-ICU mortality was 53.4% (95% CI, 48.5-58.4%). A total of 186 patients were admitted to the ICU due to infection. Pneumonia (320/391, 81.8%) was the most common clinical manifestation, followed by renal disease (246/391, 62.9%). Nine prognostic factors were identified. The model had C statistic of 0.912 (95% CI, 0.889-0.948) and 0.807 (95% CI 0.703-0.889), with predictive range of 5.2-98.3% and 6.3-94.7% for the derivation and validation groups, respectively. Based on distribution of the risk score, 25.3, 49.5, and 25.2% of patients were stratified into the high, average, and low-risk groups, with corresponding in-ICU mortality of 0.937, 0.593, and 0.118, respectively. Nine prognostic factors including age, white blood cell count, alanine transaminase, uric acid, intracranial infection, shock, intracranial hemorrhage, respiratory failure, and cyclosporin A/tacrolimus usage were identified. A prognostic model was developed and evaluated to predict in-ICU mortality of patients with SLE. These findings may help clinicians to prognostically stratify patients into different risk groups of in-ICU mortality, and provide patients with intensive and targeted management.
系统性红斑狼疮（SLE）患者有时可能需要入住重症监护病房（ICU），且预后较差。本研究旨在探讨ICU中SLE患者的临床特征，识别预后因素，并开发和评估一种预测SLE患者ICU内死亡率的预后模型。这是一项在中国一家三级医疗机构进行的单中心回顾性研究。筛选了2010年至2019年期间共480例SLE患者的505次ICU入院病例，纳入了391例患者。分析了患者的临床特征和结局。根据随机数字表，将患者分为两个相互独立的组，即推导组（n = 293）和验证组（n = 98）。通过带有马尔可夫链蒙特卡罗模拟的Cox模型识别预后因素，并通过潜在分析进行评估。基于推导组开发风险评分，并使用验证组进行评估。在391例患者中，348例（89.0%）为女性。患者的中位年龄为34岁，SLE的中位病程为6个月。APACHE II和SLEDAI的中位数分别为17和10。ICU内平均死亡率为53.4%（95%CI，48.5 - 58.4%）。共有186例患者因感染入住ICU。肺炎（320/391，81.8%）是最常见的临床表现，其次是肾脏疾病（246/391，62.9%）。识别出9个预后因素。该模型在推导组和验证组的C统计量分别为0.912（95%CI，0.889 - 0.948）和0.807（95%CI 0.703 - 0.889），预测范围分别为5.2 - 98.3%和6.3 - 94.7%。根据风险评分分布，25.3%、49.5%和25.2%的患者被分层为高、中、低风险组，相应的ICU内死亡率分别为0.937、0.593和0.118。识别出包括年龄、白细胞计数、丙氨酸转氨酶、尿酸、颅内感染、休克、颅内出血、呼吸衰竭以及环孢素A/他克莫司使用情况在内的9个预后因素。开发并评估了一种预测SLE患者ICU内死亡率的预后模型。这些发现可能有助于临床医生将患者在预后方面分层为不同的ICU内死亡风险组，并为患者提供强化和有针对性的管理。
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