Background/Purpose:

Patients with autoimmune rheumatic diseases have higher risk of developing organ failure and may require admission to intensive care unit (ICU), however there are only few studies in the US addressing this topic. The aim of our study is to determine reasons of admission to the ICU, identify potential risk factors associated with mortality and assess outcomes of patients with rheumatic disease admitted to the ICU.

Methods:

We conducted a retrospective chart review of patients admitted to the ICU from 2011 to 2016 using ICD-9/ICD-10 codes for morbidities. We identified patients with new or established diagnosis of a rheumatic disease. Patient’s data included demographics, ICU admission diagnoses, co-morbidities, organ involvement, laboratory studies, length of stay in ICU/hospital, complications and immunosuppresive regimen. Short-term (ICU/30-day post-ICU) stay and long-term (1-year post) outcomes were assessed.

Results:

A total of 80 rheumatic disease patients were identified with mean age of 48.8 (range 19-84), 67% were female, 56% were Hispanic. Most common disease associated with ICU admission was SLE in 34 patients (42%), followed by RA 21(26%). 10(12%) had Systemic Vasculitis (5 with Granulomatosis with polyangitis, 2 with PAN, 1 Eosinophilic granulomatosis with polyangiitis, 1 with Takayasu’s, 1 with Microscopic polyangiitis). 5(6%) had SSc, 5(6%) had DM and 2(3%) had Sarcoidosis. Sjogren’s, APS and AS were present in 1 patient each case.

Sepsis was the leading cause of ICU admission with 25 patients(31%), followed by acute hypoxemic respiratory failure due to pneumonia 8(10%) and congestive heart failure/CHF 8(10%). Others were respiratory failure due to underlying disease 6(8%) and cardiac tamponade 6 (8%). Less common included cerebrovascular events(4), metabolic disturbances(3), Steven’s Johnson (3), meningoencephalitis (3), encephalopathy(3), pulmonary hypertensions(2), diffuse alveolar hemorrhage (2), pancreatitis(2), cardiac arrest(2), anemia(1), hypertensive emergency(1) and pulmonary embolism(1).

45% of patients required mechanical ventilation and 31% vasopressor support. Mean ICU stay was 7 days and hospital stay 13.7 days. 16 of 80 patients (20%) died in ICU, 4(5%) died 30-days post-ICU and 6(7.5%) within 1-year of ICU stay, resulting into an overall mortality of 33% by the end of 1-year. Higher mortality found in patients with DM (40%) and SLE (24%). Predictors of increased mortality during ICU stay were cardiovascular involvement (p=0.01), renal involvement (p=0.032) and requirement for mechanical ventilation (p<0.01). Worse outcome 30-days post ICU stay was influenced by development of venous thromboembolic disease (VTE) during hospitalization (p=0.03). At 1-year post ICU-stay, survival for patients with CHF was 76.5% compared to 95.7% without CHF (p=0.041).

Conclusion:

Our findings indicated that SLE is the most common rheumatic disease associated with ICU admission, followed by RA. Sepsis, respiratory failure due to pneumonia/ CHF were the most common causes leading to ICU admission. Factors associated with higher mortality were requirement for mechanical ventilation, renal and cardiovascular involvement on admission, development of VTE and history of CHF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/intensive-care-unit-admissions-among-patients-with-rheumatic-diseases-at-a-tertiary-care-center/