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Original Research: Critical Care |

Outcomes in Critically Ill Patients With Systemic Rheumatic DiseaseA Multicenter Study: A Multicenter Study

Guillaume Dumas, MD; Guillaume Géri, MD; Claire Montlahuc, MD; Sarah Chemam, MD; Laurence Dangers, MD; Claire Pichereau, MD; Nicolas Brechot, MD; Matthieu Duprey, MD; Julien Mayaux, MD; Maleka Schenck, MD; Julie Boisramé-Helms, MD, PhD; Guillemette Thomas, MD; Loredana Baboi, PhD; Luc Mouthon, MD, PhD; Zair Amoura, MD, PhD; Thomas Papo, MD, PhD; Alfred Mahr, MD, PhD; Sylvie Chevret, MD, PhD; Jean-Daniel Chiche, MD, PhD; Elie Azoulay, MD, PhD
Author and Funding Information

From the Medical Intensive Care Unit (Drs Dumas and Azoulay), the Biostatistics Department (Drs Montlahuc and Chevret), and the Department of Internal Medicine (Dr Mahr), Saint-Louis Teaching Hospital, Paris; the Medical Intensive Care Unit (Drs Géri and Chiche), Cochin Teaching Hospital, Paris; the Medical Intensive Care Unit (Dr Chemam) and the Department of Internal Medicine (Dr Papo), Bichat Hospital, Paris; Service de réanimation médicale (Drs Dangers, Brechot, and Duprey), Institut de Cardiologie, the Medical Intensive Care Unit (Dr Mayaux), and the Department of Internal Medicine (Dr Amoura), Pitié-Salpêtrière Teaching Hospital, Paris; Réanimation médicale (Dr Pichereau), Saint-Antoine Teaching Hospital, Paris; the Medical Intensive Care Unit (Dr Schenck), Hautepierre Teaching Hospital, Strasbourg; the Medical Intensive Care Unit (Dr Boisramé-Helms), Nouvel Hôpital Civil, Strasbourg Teaching Hospital, Strasbourg; Assistance-Publique-Hôpitaux de Marseille (Dr Thomas), Hôpital Nord, Réanimation des Détresses respiratoires et des Infections Sévères, Marseille; Réanimation médicale (Dr Baboi), Hôpital de la Croix-Rousse, Lyon; and Université Paris-Descartes (Dr Mouthon), Department of Internal Medicine, Cochin Teaching Hospital, Paris, France.

CORRESPONDENCE TO: Elie Azoulay, MD, PhD, Medical Intensive Care Unit, Hôpital Saint-Louis, 1 Ave Claude Vellefaux, 75010 Paris, France; e-mail: elie.azoulay@sls.aphp.fr


FUNDING/SUPPORT: This study was supported by Paris Diderot University.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):927-935. doi:10.1378/chest.14-3098
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BACKGROUND:  Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities.

METHODS:  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.

RESULTS:  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.

CONCLUSIONS:  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.


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