Systemic lupus erythematosus in the intensive care unit: a systematic review

Lupus ◽  
2020 ◽  
Vol 29 (11) ◽  
pp. 1364-1376
Author(s):  
Ana Suárez-Avellaneda ◽  
Jhon H Quintana ◽  
Cristian C Aragón ◽  
Linda M Gallego ◽  
Cindy-Natalia Gallego ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Apache Score ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Pathophysiologic Mechanisms

Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%–78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.

Factors associated with infection amongst paediatric patients with systemic lupus erythematosus treated in the intensive care unit

Lupus ◽  
2019 ◽  
Vol 28 (9) ◽  
pp. 1141-1147 ◽  
Author(s):  
M Restrepo-Escobar ◽  
N A Ríos ◽  
LJ Hernández-Zapata ◽  
M Velásquez ◽  
R Eraso
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Lupus Erythematosus ◽  
Retrospective Cohort ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Multivariate Adjustment

Objective To identify determinants and outcomes associated with infection in paediatric systemic lupus erythematosus (SLE) patients at admission and during hospitalization in intensive care units (ICUs). Patients and methods A retrospective cohort study of paediatric SLE patients admitted to two ICUs was conducted. Frequency and risk factors of infection as well as mortality were studied. Results Seventy-three infection episodes amongst 55 patients were analysed. The median age was 14.4 years (IQR 12.5–16). The median SLEDAI was 16 (IQR 12–20). Twenty-nine episodes were documented at admission; the CRP was higher in these patients (6.58 versus 1.04 mg/dl, p<0.001) than in non-infected patients, even after multivariate adjustment (OR 8.6, 95% CI = 2.1–34.8, p = 0.003). Twenty-five (34.7%) episodes occurred during hospitalization. Lupus activity (OR 1.14, 95% CI = 1.01–1.27, p = 0.029), cyclophosphamide (OR 17.9, 95% CI = 2–156, p = 0.009) and mechanical ventilation (OR 16, 95% CI = 2.1–122, p = 0.008) were associated with infection. Ten episodes (14%) led to death. Admission to the ICU due to infection was strongly associated with mortality (90% versus 31.8%, OR 19.4, 95% CI = 2.3–163, p = 0.006). Conclusion In paediatric lupus patients admitted to the ICU, elevated CRP should alert clinicians to possible infection. During hospitalization, SLE activity and cyclophosphamide were associated with infection. Infection at admission to the ICU was strongly associated with mortality.

scholarly journals Nocardia Sepsis in a Multigravida with Systemic Lupus Erythematosus and Autoimmune Hepatitis

2007 ◽  
Vol 35 (4) ◽  
pp. 601-604 ◽  
Author(s):  
C. L. Cassar
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Autoimmune Hepatitis ◽  
Lupus Erythematosus ◽  
Intrauterine Death ◽  
Cardiovascular Collapse ◽  
Systemic Lupus

This report describes a pregnant woman with systemic lupus erythematosus and autoimmune hepatitis who presented with threatened labour and acute renal failure. She developed respiratory distress, haematemesis and became coagulopathic. Intrauterine death occurred and she was admitted to the intensive care unit after caesarean section. She suffered sudden cardiovascular collapse and succumbed. At autopsy, Nocardia was cultured from multiple renal abscesses. The co-existence of Nocardia sepsis, systemic lupus erythematosus, autoimmune hepatitis and pregnancy are discussed. This case illustrates diagnostic challenges associated with Nocardia infection in the presence of co-existing disease.

scholarly journals Development of a Novel Simple Model to Predict Mortality in Patients With Systemic Lupus Erythematosus Admitted to the Intensive Care Unit

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinyan Guo ◽  
Zhen Huang ◽  
Maoxin Huang ◽  
Yujie He ◽  
Bing Han ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Risk Score ◽  
Lupus Erythematosus ◽  
Prognostic Model ◽  
Risk Groups ◽  
Systemic Lupus ◽  
Icu Mortality

Background: Patients with systemic lupus erythematosus (SLE) may sometimes require admission to the intensive care unit (ICU), and the outcome is poor. The aim of this study was to explore the clinical features of patients with SLE in the ICU, identify prognostic factors, and develop and evaluate a prognostic model to predict in-ICU mortality of patients with SLE.Patients and Methods: This was a single center retrospective study in a tertiary medical institution in China. A total of 480 SLE patients with 505 ICU admissions from 2010 to 2019 were screened, and 391 patients were enrolled. The clinical feature and outcomes of the patients were analyzed. According to the random number table, patients were divided into two mutually exclusively groups named derivation (n = 293) and validation (n = 98). Prognostic factors were identified by a Cox model with Markov Chain Monte Carlo simulation and evaluated by latent analysis. The risk score was developed based on the derivation group and evaluated using the validation group.Results: Among the 391 patients, 348 (89.0%) patients were females. The median age of patients was 34 years, and the median course of SLE was 6 months. The median APACHE II and SLEDAI were 17 and 10, respectively. The average in-ICU mortality was 53.4% (95% CI, 48.5–58.4%). A total of 186 patients were admitted to the ICU due to infection. Pneumonia (320/391, 81.8%) was the most common clinical manifestation, followed by renal disease (246/391, 62.9%). Nine prognostic factors were identified. The model had C statistic of 0.912 (95% CI, 0.889–0.948) and 0.807 (95% CI 0.703–0.889), with predictive range of 5.2–98.3% and 6.3–94.7% for the derivation and validation groups, respectively. Based on distribution of the risk score, 25.3, 49.5, and 25.2% of patients were stratified into the high, average, and low-risk groups, with corresponding in-ICU mortality of 0.937, 0.593, and 0.118, respectively.Conclusion: Nine prognostic factors including age, white blood cell count, alanine transaminase, uric acid, intracranial infection, shock, intracranial hemorrhage, respiratory failure, and cyclosporin A/tacrolimus usage were identified. A prognostic model was developed and evaluated to predict in-ICU mortality of patients with SLE. These findings may help clinicians to prognostically stratify patients into different risk groups of in-ICU mortality, and provide patients with intensive and targeted management.

PROGNOSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS IN THE INTENSIVE CARE UNIT (ICU)

1998 ◽  
Vol 26 (Supplement) ◽  
pp. 95A
Author(s):  
Raul Gonzalez ◽  
Isabel De La Rosa-Ramirez ◽  
Jorge Pedroza ◽  
Guillermo Dominguez-Cherit
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Lupus Erythematosus ◽  
Systemic Lupus
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