Outcomes of patients admitted to intensive care units for acute manifestation of small-vessel vasculitis: a multicenter, retrospective study.
Abstract | BACKGROUND: The outcomes of patients admitted to the intensive care unit (ICU) for acute manifestation of small-vessel vasculitis are poorly reported. The aim of the present study was to determine the mortality rate and prognostic factors of patients admitted to the ICU for acute small-vessel vasculitis. METHODS: RESULTS: Eighty-two patients at 20 centers were included, 94% of whom had a recent (<6 months) diagnosis of small-vessel vasculitis. Forty-four patients (54%) had granulomatosis with polyangiitis. The main reasons for admission were respiratory failure (34%) and pulmonary-renal syndrome (33%). Mechanical ventilation was required in 51% of patients, catecholamines in 31%, and renal replacement therapy in 71%. Overall mortality at 90 days was 18% and the mortality in ICU was 16 %. The main causes of death in the ICU were disease flare in 69% and infection in 31%. In univariable analysis, relevant factors associated with death in nonsurvivors compared with survivors were Simplified Acute Physiology Score II (median [interquartile range] 51 [38-82] vs. 36 [27-42], p = 0.005), age (67 years [62-74] vs. 58 years [40-68], p < 0.003), Sequential Organ Failure Assessment score on the day of cyclophosphamide administration (11 [6-12] vs. 6 [3-7], p = 0.0004), and delayed administration of cyclophosphamide (5 days [3-14] vs. 2 days [1-5], p = 0.0053). CONCLUSIONS: Patients admitted to the ICU for management of acute small-vessel vasculitis benefit from early, aggressive intensive care treatment, associated with an 18% death rate at 90 days.
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Authors | Antoine Kimmoun, Elisabeth Baux, Vincent Das, Nicolas Terzi, Patrice Talec, Pierre Asfar, Stephan Ehrmann, Guillaume Geri, Steven Grange, Nadia Anguel, Alexandre Demoule, Anne Sophie Moreau, Elie Azoulay, Jean-Pierre Quenot, Julie Boisramé-Helms, Guillaume Louis, Romain Sonneville, Nicolas Girerd, Nicolas Ducrocq, Nelly Agrinier, Denis Wahl, Xavier Puéchal, Bruno Levy |
Journal | Critical care (London, England)
(Crit Care)
Vol. 20
Pg. 27
(Jan 26 2016)
ISSN: 1466-609X [Electronic] England |
PMID | 26812945
(Publication Type: Journal Article)
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Topics |
- Aged
- Female
- France
- Hospital Mortality
- Humans
- Intensive Care Units
(statistics & numerical data)
- Male
- Middle Aged
- Patient Outcome Assessment
- Prognosis
- Retrospective Studies
- Vasculitis
(mortality)
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