Background Systemic rheumatic diseases (SRD) are a rare and heterogeneous group of diseases, associated with a high mortality rate due to the natural evolution of the disease and/or consequences of their specific treatments (infections, toxicity).
Objectives To describe the clinical features, outcomes and prognostic factors for patients with SRD admitted to the intensive care unit (ICU).
Methods Single-center retrospective observational cohort study of 98 patients with SRD over an 11-year period in an ICU of a French teaching hospital.
Results Ninety-eight patients (57% women; median age, 57 years [19–81years]) accounted for 108 admissions. Connective tissue disease (primarily systemic lupus erythematosus) and systemic vasculitides (mainly ANCA-associated vasculitides) represented respectively 55% and 30% of SRD. For nineteen patients, diagnosis of SRD was made at admission. Reasons for admission were: SRD exacerbations (43%), isolated infections (34%), SRD exacerbations associated with infections (12%) or other (11%). Respiratory failure was the most common organ dysfunction. Mechanical ventilation was necessary for 43 patients (44%), vasoactive drugs for 47 (48%) and extra-renal replacement therapy for 38 (39%). The ICU mortality rate was 30% and 37% one year after admission. Infection was the main cause of death (69%). The factors significantly associated with mortality in the ICU were (multivariate analysis): diabetes, cardiovascular diseases and immunosuppressive treatments on admission. At 1 year of follow-up, additional risk factors were: number of organ dysfunction at ICU admission and mechanical ventilation. It is to be noted that at 1 year of follow-up, diabetes was not anymore a prognostic factor.
Conclusions Patients with SRD admitted to the ICU have a severe prognosis. Causes of mortality are mainly infections. Our study points out the importance of vaccination and developing new therapeutic strategies. Diagnosis of SRD in the ICU is not rare and should be systematically considered on admission. Prognostic factors of mortality in the ICU were patient comorbidities and immunosuppressive therapy at admission. In addition, mechanical ventilation and multiple organ failure were risk factors for mortality at 1 year.
Disclosure of Interest None declared