Background/Purpose: To describe the clinical characteristics of a 20-year cohort of patients with systemic autoimmune diseases (SAD) admitted to a medical intensive care unit (ICU) and to identify mortality prognostic factors.

Methods: A single-center retrospective, observational study including all adult patients with SAD admitted to a medical ICU of a tertiary referral center between 1999 and 2019. Adults with a SAD diagnosis according to accepted criteria and made prior or during to ICU admission were included. Patients with ICU stay less than 48 hours and those with short-term irreversible disease were excluded. The reason for ICU admission, clinical follow-up, immunosuppressive treatment received before and during ICU admission, and outcome were collected. The association between the outcome (ICU death or survival) and predictors variables was measured by odds ratio using logistic regression models.

Results: One hundred patients accounting for 111 ICU admissions (34.2% male) with a mean age of 62 [40-74] years were included. Most patients had systemic lupus erythematosus (SLE) (29.5%) or systemic vasculitis (38.7%). Comorbidities were present in 60 (68.2%) patients at ICU admission being the chronic kidney disease (25.2%) the most frequent followed by interstitial lung disease (18.9%). Seventy-five (67.6%) patients were under immunosuppressive treatment before ICU admission. The reasons for ICU admission were infection in 41 (36.9%) patients followed by autoimmune disease flare-up in 30 (27%). Other complications related or not to the SAD were present in 32 (28.8%) patients. At admission, 73 (65.5%) patients had respiratory failure and 41 (56.2%) of them required mechanical ventilation. Fifty (45%) patients had acute kidney injury and 41 (36.3%) required vasoactive drugs due to hemodynamic instability at admission. The mean ICU length of stay (LOS) was 8 [IQR 4-18] days and hospital LOS was 26 [IQR 13.5-45] days. A total of 25 (22.1%) patients died in the ICU (40% male) being septic shock and respiratory failure the most frequent causes. Multivariable analysis demonstrated that chronic kidney disease (OR 3.5, 95%CI 1.1-11.0, [p=0.036]), corticosteroid treatment prior to ICU admission (OR 3.2, 95%CI 1.1-9.7, [p=0.04]), and the need of mechanical ventilation during ICU admission (OR 4.8, 95%CI 1.5-15.5, [p: 0.008]) were associated independently with ICU mortality after adjusting for age and sex.

Conclusion: The most prevalent SADs admitted to a medical ICU were SLE and systemic vasculitis being infection the main reason for admission. The presence of renal failure, corticosteroid treatment before ICU admission, and the need for mechanical ventilation during ICU stay were factors associated with increased risk of mortality.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-prognostic-factors-of-critically-ill-patients-with-systemic-autoimmune-diseases-admitted-in-a-medical-intensive-care-unit-a-20-year-cohort-study/