Clinical characteristics and prognostic factors of patients with systemic lupus erythematosus in the intensive care unit

doi:10.3877/cma.j.issn.2096-1537.2021.02.006

Abstract

Abstract:

Objective

To discuss the clinical features and prognostic factors in patients with systemic lupus erythematosus (SLE) in intensive care unit (ICU).

Methods

The clinical data of patients with SLE who were admitted in the medical ICU of our hospital from Jan 2013 to Jun 2019 were retrospectively analyzed. Major clinical data include age, gender, age, years of disease, major organ involvement, SLE disease activity index (SLEDAI), acute physiology and chronic health (APACHEⅡ) score, duration of ICU and hospital stay, reason of ICU admission and treatments during the ICU stay (including glucocorticoids, immunosuppressors, high dose immunoglobulin, invasive mechanical ventilation, hemodialysis, vascular active drugs), and laboratory results.

Results

A total of 61 patients were evaluated in this study. Most patients were female (68.85%), and APACHEⅡ score was(18.93±7.62). The leading causes of admission were infection and acute heart failure. Multivariable logistic regression showed that APACHEⅡ score ≥ 20 point,administration with vasopressors and sepsis (OR=23.326, 95%CI: 2.307-235.896, P=0.008; OR=26.218, 95%CI: 1.641-418.897, P=0.021; OR=17.194, 95%CI: 1.332-221.945, P=0.029) were significantly associated with mortality.

Conclusion

The outcome of SLE patients admitted in the ICU is poor. APACHEⅡ score ≥ 20 point, administration with vasopressors and sepsis are risk factors of death.

Key words: Systemic lupus erythematosus, Clinical characteristics, Prognosis

Junhui Ba, Yanhong Wang, Jiajia Hu, Benquan. Wu. Clinical characteristics and prognostic factors of patients with systemic lupus erythematosus in the intensive care unit[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 126-131.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.02.006

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I02/126

Figures/Tables 5

基本特征	结果
性别［女，例（%）］	42（68.85）
年龄（岁， $x ¯$ ±s）	37.36±16.25
疾病时间［个月，M（Q₂₅，Q₇₅）］	4（0.5~48）
SLEDAI（分， $x ¯$ ±s）	13.66±8.28
入ICU前SLE受累器官或系统［例（%）］
肾脏	24（39.34）
皮肤黏膜	12（19.67）
肺脏	7（11.48）
关节	7（11.48）
浆膜	48（78.69）
神经系统	13（21.31）
心脏	22（36.07）
消化系统	4（6.56）
入ICU前1个月使用激素［例（%）］	46（75.41）
入ICU前甲泼尼龙琥珀酸钠等效剂量［mg，M（Q₂₅，Q₇₅）］	28（0，40）
APACHEⅡ评分（分， $x ¯$ ±s）	18.93±7.62
ICU住院时间（d， $x ¯$ ±s）	7.95±7.18
总住院时间（d， $x ¯$ ±s）	23.59±18.28
SLE首发症状［例（%）］
乏力	1（1.64）
消化道症状	1（1.64）
泡沫尿	1（1.64）
全血细胞减少	1（1.64）
意识障碍	2（3.28）
咽痛	2（3.28）
胸腔积液	2（3.28）
气促	3（4.92）
发热	8（13.11）
皮疹	16（26.23）
关节痛	14（22.95）
水肿	25（40.98）
雷诺现象	1（1.64）
脱发	2（3.28）
合并症［例（%）］
甲状腺功能亢进	1（1.64）
冠心病	1（1.64）
肺结核	1（1.64）
糖尿病	2（3.28）
乙型肝炎	3（4.92）
肾病综合征	3（4.92）
高血压病	12（19.67）

基本特征	结果
性别［女，例（%）］	42（68.85）
年龄（岁， $x ¯$ ±s）	37.36±16.25
疾病时间［个月，M（Q₂₅，Q₇₅）］	4（0.5~48）
SLEDAI（分， $x ¯$ ±s）	13.66±8.28
入ICU前SLE受累器官或系统［例（%）］
肾脏	24（39.34）
皮肤黏膜	12（19.67）
肺脏	7（11.48）
关节	7（11.48）
浆膜	48（78.69）
神经系统	13（21.31）
心脏	22（36.07）
消化系统	4（6.56）
入ICU前1个月使用激素［例（%）］	46（75.41）
入ICU前甲泼尼龙琥珀酸钠等效剂量［mg，M（Q₂₅，Q₇₅）］	28（0，40）
APACHEⅡ评分（分， $x ¯$ ±s）	18.93±7.62
ICU住院时间（d， $x ¯$ ±s）	7.95±7.18
总住院时间（d， $x ¯$ ±s）	23.59±18.28
SLE首发症状［例（%）］
乏力	1（1.64）
消化道症状	1（1.64）
泡沫尿	1（1.64）
全血细胞减少	1（1.64）
意识障碍	2（3.28）
咽痛	2（3.28）
胸腔积液	2（3.28）
气促	3（4.92）
发热	8（13.11）
皮疹	16（26.23）
关节痛	14（22.95）
水肿	25（40.98）
雷诺现象	1（1.64）
脱发	2（3.28）
合并症［例（%）］
甲状腺功能亢进	1（1.64）
冠心病	1（1.64）
肺结核	1（1.64）
糖尿病	2（3.28）
乙型肝炎	3（4.92）
肾病综合征	3（4.92）
高血压病	12（19.67）

原因	例数（%）
急性肾衰竭	9（14.75）
急性呼吸衰竭	13（21.31）
狼疮性肺炎（出血性肺泡炎）	4（6.56）
肺纤维化	1（1.64）
肺部感染	8（13.11）
急性心力衰竭	22（36.07）
肺动脉高压	2（3.28）
心瓣膜病变	4（6.56）
心肌病变	5（8.20）
其他	11（18.03）
精神异常	13（21.31）
感染	23（37.70）
肺部感染	16（69.57）
败血症	4（6.56）
腹腔感染	1（1.64）
颅内感染	2（3.28）
严重血液系统损害	6（9.84）
休克	6（9.84）
乳酸酸中毒	7（11.48）
心跳呼吸骤停	2（3.28）

相关因素	存活（30例）	死亡（31例）	χ²值	P值
急性肾损伤	7	8	0.050	0.823
慢性肾衰竭	7	8	0.050	0.823
精神障碍	6	6	0.004	0.949
消化道出血	2	2	0.001	0.973
感染性休克	0	9	10.217	0.001
淋巴细胞减少	16	16	0.018	0.893
血小板减少	11	20	4.731	0.030
APACHEⅡ≥20分	5	23	20.318	＜0.001
ARDS	1	8	6.122	0.013
脓毒症	4	16	10.138	0.001
升压药	3	20	19.291	＜0.001
机械通气	7	24	17.844	＜0.001
CRRT	10	16	2.083	0.149
SLEDAI≥15	14	14	0.014	0.906
甲泼尼龙琥珀酸钠≥80 mg/d	29	30	0.001	0.981
羟氯喹	16	11	1.969	0.161
环磷酰胺冲击	3	7	1.761	0.185

相关因素	OR	95%CI	P值
APACHEⅡ≥20分	23.326	2.307~235.896	0.008
血管活性药物应用	26.218	1.641~418.897	0.021
ARDS	29.788	0.732~1212.226	0.073
机械通气	1.221	0.139~10.696	0.857
血小板减少	0.975	0.158~6.020	0.979
脓毒症	17.194	1.332~221.945	0.029

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