The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit

AYDIN, Kaniye; Türk, İpek

The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit

Kaniye AYDIN, (Çukurova Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Tıbbi Yoğun Bakım Ünitesi, Adana, Türkiye)

İpek TÜRK (Çukurova Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Romatoloji Anabilim Dalı, Adana, Türkiye)

Turkish Journal of Medical Sciences

3 0

Yıl: 2023 Cilt: 53 Sayı: 5 Sayfa Aralığı: 1084 - 1093 Metin Dili: İngilizce İndeks Tarihi: 24-11-2023

The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit

Öz:

Background/aim: Immunosuppressive and immunomodulatory treatments developed in recent years as a result of a better understanding of the pathophysiology of systemic rheumatic diseases (SRDs) improve the prognosis. Despite medical advances, individuals with SRDs at any stage may require intensive care and have a high mortality rate. The aim of this study was to investigate the demographic and clinical characteristics of patients with rheumatic diseases admitted to the intensive care unit (ICU), and the factors associated with the risk of mortality. Materials and methods: This was a retrospective, cross-sectional study that included patients with rheumatic diseases in the medical ICU. Factors of ICU 28-day mortality were identified by multiple-variable logistic analysis. Results: A total of 127 patients with SRDs admitted to the medical ICU were enrolled. Systemic lupus erythematosus (SLE) (32.3%) was the most common diagnosis of SRDs in patients admitted to the ICU. The reasons for admission to the ICU were combined infection and primary SRD flare-up (35.4%), primary SRD flare-up (22%), SRD-unrelated reasons (22%), infection (17.3%), drug side effects (3.9%), and SRD-related complications (0.8%). The most common organ dysfunctions before (49.6%) and during (77.2%) admission to ICU were in the respiratory system. The 28-day mortality was 78 (61.4%). While the maximum procalcitonin, serum lactate, and blood urea nitrogen (BUN) levels were higher in the nonsurvivor group, the platelet and serum albumin levels were statistically significantly lower than those in the survivor group (p < 0.05). Acute respiratory failure (ARF), the presence of septic shock, the need for invasive mechanical ventilation (IMV), BUN level, and low platelet-lymphocyte ratio (PLR) were significant in the final multiple-variable model. Conclusion: Significant predictors of mortality in patients with rheumatic diseases may include ARF, septic shock, the need for IMV, and high BUN and low PLR levels.

Anahtar Kelime: Flare-up infection intensive care unit mortality systemic lupus erythematosus systemic rheumatic disease platelet to lymphocyte ratio

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Janssen NM, Karnad DR, Guntupalli KK. Rheumatologic diseases in the intensive care unit: Epidemiology, clinical approach, management, and outcome. Critical Care Clinics 2002; 18 (4): 729-748. https://doi.org/10.1016/s0749- 0704(02)00025-8
2. Faguer S, Ciroldi M, Mariotte E, Galicier L, Rybojad M et al. Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases. European Journal Internal Medicine 2013; 24 (3): e40-e44. https://doi.org/10.1016/j. ejim.2012.11.018
3. Dumas G, Géri G, Montlahuc C, Chemam S, Dangers L et al. Outcomes in critically ill patients with systemic rheumatic disease: A multicenter study. Chest 2015; 148 (4): 927-935. https://doi.org/10.1378/chest.14-3098
4. Mustafa M, Gladston Chelliah E, Hughes M. Patients with systemic rheumatic diseases admitted to the intensive care unit: what the rheumatologist needs to know. Rheumatology International 2018; 38 (7): 1163-1168. https://doi.org/10.1007/ s00296-018-4008-2
5. Camargo JF, Tobón GJ, Fonseca N, Diaz JL, Uribe M et al. Autoimmune rheumatic diseases in the intensive care unit: Experience from a tertiary referral hospital and review of the literature. Lupus 2015; 14: 315-320. https://doi. org/10.1191/0961203305lu2082oa
6. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheumatology 1997; 40 (9): 1725. https://doi.org/10.1002/art.1780400928
7. Petri M, Orbai A, Alarcón GS, Gordon C, Merrill JT et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheumatology 2012; 64 (8): 2677- 2686. https://doi.org/10.1002/art.34473
8. Aringer M, Costenbader KH, Daikh DI, Brinks R, Mosca M et al. 2019 EULAR/ACR classification criteria for systemic lupus erythematosus. Arthritis Rheumatology 2019; 71 (9): 1400- 1412. https://doi.org/10.1002/art.40930
9. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheumatology 1988; 31 (3): 315-324. https://doi.org/10.1002/ art.1780310302
10. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology 2012; 51 (6): vi5-vi9. https://doi.org/10.1093/rheumatology/kes279
11. Watts R, Lane S, Hanslik T, Hauser T, Hellmich B et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Annals of the Rheumatic Diseases 2007; 66: 222-227. https://doi.org/10.1136/ ard.2006.054593
12. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC et al. 2012 Revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis Rheumatology 2013; 65: 1-11. https://doi.org/10.1002/art.37715
13. Leroy EC, Medsger TA Jr. Criteria for the classification of early systemic sclerosis. The Journal of Rheumatology. 2001; 8 (7): 1573–1576
14. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Annals of the Rheumatic Diseases 2013; 72 (11): 1747-1755. https://doi.org/10.1136/ annrheumdis-2013-204424
15. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine 2003; 31 (4): 1250-1256. https://doi.org/10.1097/01.CCM.0000050454.01978.3B
16. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801- 810. https://doi.org/10.1001/jama.2016.0287
17. Shi Y, Du B, Zhao JL, Qin HY, Hu XY et al. Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients. Clinical Rheumatology 2020; 39 (11): 3479-3488. https://doi.org/10.1007/s10067-020-05080-w
18. Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Annals of Internal Medicine 2013; 158 (11): 825-830. https://doi. org/10.7326/0003-4819-158-11-201306040-00007
19. Brünnler T, Susewind M, Hoffmann U, Rockmann F, Ehrenstein B et al. Outcomes and prognostic factors in patients with rheumatologic diseases admitted to the ICU. Internal Medicine 2015; 54 (16): 1981-1987. https://doi.org/10.2169/ internalmedicine.54.4283
20. Chabert P, Danjou W, Mezidi M, Berthiller J, Bestion A et al. Short- and long-term prognosis of acute critically ill patients with systemic rheumatic diseases: A retrospective multicentre study. Medicine 2021; 100 (35): e26164. https://doi.org/10.1097/ MD.0000000000026164
21. Parperis K, Al-Charakh M, Nzuonkwelle S, McPherson M, Al- Marzooq A et al. Characteristics and outcomes among patients with autoimmune rheumatic diseases requiring a higher level of care. Journal of Clinical Rheumatology 2021; 27 (7): 286-291. https://doi.org/10.1097/RHU.0000000000001321
22. Zhang Y, Guo J, Zhang P, Zhang L, Duan X et al. Predictors of mortality in critically ill patients with antineutrophil cytoplasmic antibody-associated vasculitis. Frontiers in Medicine 2021; 8: 762004. https://doi.org/10.3389/fmed.2021.762004
23. Guo J, Huang Z, Huang M, He Y, Han B et al. Development of a novel simple model to predict mortality in patients with systemic lupus erythematosus admitted to the intensive care unit. Frontiers in Medicine 2021; 8: 689871. https://doi. org/10.3389/fmed.2021.689871
24. Santacruz JC, Mantilla MJ, Rueda I, Pulido S, Rodriguez-Salas G et al. A practical perspective of the hematologic manifestations of systemic lupus erythematosus. Cureus 2022; 14 (3): e22938. https://doi.org/10.7759/cureus.22938
25. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Annals of Laboratory Medicine 2019; 39 (4): 345-357. https://doi.org/10.3343/alm.2019.39.4.345
26. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open 2019; 9 (1): e022896. https://doi.org/10.1136/bmjopen-2018-022896
27. Bernal-Macías S, Reyes-Beltrán B, Molano-González N, Augusto Vega D, Bichernall C et al. Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis. Lupus Science and Medicine 2015; 2: e000122. https:// doi.org/10.1136/lupus-2015-000122
28. Arjmand M, Shahriarirad R, Shenavandeh S, Fallahi MJ. Determination of the main causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted to the medical intensive care unit in southern Iran. Clinical Rheumatology 2022; 41 (12): 3859-3868. https://doi. org/10.1007/s10067-022-06334-5

APA	AYDIN K, Türk İ (2023). The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. , 1084 - 1093.
Chicago	AYDIN Kaniye,Türk İpek The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. (2023): 1084 - 1093.
MLA	AYDIN Kaniye,Türk İpek The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. , 2023, ss.1084 - 1093.
AMA	AYDIN K,Türk İ The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. . 2023; 1084 - 1093.
Vancouver	AYDIN K,Türk İ The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. . 2023; 1084 - 1093.
IEEE	AYDIN K,Türk İ "The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit." , ss.1084 - 1093, 2023.
ISNAD	AYDIN, Kaniye - Türk, İpek. "The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit". (2023), 1084-1093.

APA	AYDIN K, Türk İ (2023). The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. Turkish Journal of Medical Sciences, 53(5), 1084 - 1093.
Chicago	AYDIN Kaniye,Türk İpek The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. Turkish Journal of Medical Sciences 53, no.5 (2023): 1084 - 1093.
MLA	AYDIN Kaniye,Türk İpek The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. Turkish Journal of Medical Sciences, vol.53, no.5, 2023, ss.1084 - 1093.
AMA	AYDIN K,Türk İ The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. Turkish Journal of Medical Sciences. 2023; 53(5): 1084 - 1093.
Vancouver	AYDIN K,Türk İ The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit. Turkish Journal of Medical Sciences. 2023; 53(5): 1084 - 1093.
IEEE	AYDIN K,Türk İ "The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit." Turkish Journal of Medical Sciences, 53, ss.1084 - 1093, 2023.
ISNAD	AYDIN, Kaniye - Türk, İpek. "The Diagnostic profile and clinical course of patients with rheumatic diseases in the medical intensive care unit". Turkish Journal of Medical Sciences 53/5 (2023), 1084-1093.