The clinical course of rheumatologic disorder (RD) in intensive care unit (ICU) remains undefined. Our objective is to study the reason of admission and clinical outcome of the patients admitted to ICU with RD.METHOD: We retrospectively examined the clinical course of RD (admitted with past medical history or newly diagnosed RD) in critically ill patients (admitted to the ICU between Jan 2000 and December 2002. Patients with RD and admitted to ICU were identified based on ICD-9 coding and hospital database search. Data collected include demographics, co-morbid conditions, APACHE II (acute physiology and chronic health evaluation score;TISS score (therapeutic intervention scoring system), cause for ICU admission, respiratory failure (defined as need for mechanical ventilation/ Non invasive positive pressure ventilation), hospital length of stay (LOS), ICU LOS and mortality were recorded.
Fourty nine patients met the above criteria. Diagnosis included systemic lupus erythematosus (SLE) (65%), rheumatoid arthritis (26%), polymyositis (4%), mixed connective tissue disorder (1%), and others (4%) included scleroderma, Sjogrens disease, gout, vasculitis. The common causes for admission to ICU were cardiac (36%) majority of whom were females, sepsis (12 %), neurological (8%) surgical (8%) mutlisystem (36%). 12 patients required mechanical ventilation of which 3 (25%) died. The other results are shown below
Age of patients (mean± SD, years)56 ± 19M/ F9: 40Caucasian: Black: Hispanic29:11:8LOS in the hospital < 7 days57% > 7 days43%LOS in ICU < 7 days > 7 days83% > 7 days17%Mortality10%Need for mechanical ventilation24%APACHE II (mean± SD)13.26 + 6.1TISS score18.53 + 14.9Immunosuppresive drugs91%CONCLUSIONS: Inhospital mortality was 10%. Mortality was higher in patients on mechanical ventialtion. Mean APACHE score was 13 which correlated well with the predicted mortality of 10% to 14%. The most common cause of admission to ICU was cardiac. The most common underlying RD was SLE.
Even though majority of the patients were on immunosupressives, the most common admission reason was cardiac and not sepsis, hence, more attention should be paid on ambulatory cardiac evaluation and risk stratification of patients with RD. Prognosis of these patietns can be anticipated on the basis of APACHE score.
A. Sheikh, None.