Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit

• Published in: Lupus Vol. 29; no. 9; pp. 1133 - 1139
• Main Authors: Aragón, Cristian C, Ruiz-Ordoñez, Ingrid, Quintana, Jhon H, Suárez-Avellaneda, Ana, Gallego, Linda M, Gallego, Cindy-Natalia, Bolaños, Juan D, Guerra, María A, Ochoa, Maria Elena, Granados, Marcela, Tobón, Gabriel J
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-08-2020; Sage Publications Ltd
• Subjects: Adult; Antiphospholipid syndrome; Antiphospholipid Syndrome - epidemiology; APACHE; Autoimmune diseases; Colombia - epidemiology; Comorbidity; Critical Care; Female; Hospital Mortality; Humans; Infections; Intensive care; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - epidemiology; Lupus Erythematosus, Systemic - mortality; Male; Mechanical ventilation; Medical prognosis; Middle Aged; Mortality; Multivariate Analysis; Organ Dysfunction Scores; Patient admissions; Patients; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Symptom Flare Up; Systemic lupus erythematosus; Vasoactive agents; Colombia; Critical care; systemic lupus erythematosus; intensive care unit
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203320935176

Objective
Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and in some conditions, admission to the intensive care unit (ICUs) is required. This study describes the clinical and prognostic factors in SLE patients admitted to the ICU.
Methods
We conducted a retrospective study that reviewed all clinical records of patients with SLE admitted to the ICU between 2011 and 2018.
Results
We evaluated 188 patients, with 279 ICU admissions. Most patients were female (n = 159; 84.57%) with a median age of 35 years (interquartile range (IQR) = 25–48 years). Infection was the leading cause of admission in 77 (27.60%) cases, followed by lupus flare. The average length of hospitalization was 5 days (IQR 3–11 days), and the SLE Disease Activity Index 2000, Acute Physiology, Age and Chronic Health Evaluation (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores were 9 (IQR 2–17), 14 (IQR 10–17), and 3 (IQR 2–5), respectively. Non-survivors presented with higher APACHE II and SOFA scores. Infection was the leading cause of mortality (n = 38; 20.21%), and predictors of mortality included invasive mechanical ventilation, vasoactive medication requirement, higher SOFA scores, and antiphospholipid syndrome comorbidity.
Conclusions
We found that infection was the leading cause of ICU admissions and mortality in patients with SLE. Factors identified here as predictors of mortality should be accurately identified at admission for the prompt treatment of SLE patients.