Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-cente
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ORIGINAL ARTICLE
Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients Yan Shi 1 & Bin Du 1 & Jiu-Liang Zhao 2 & Han-Yu Qin 1 & Xiao-Yun Hu 1 & Wei Jiang 1 & Chun-Yao Wang 1 & Li Weng 1 & Qian Wang 2 & Xiao-Feng Zeng 2 & Jin-Min Peng 1 Received: 26 February 2020 / Revised: 20 March 2020 / Accepted: 1 April 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective The etiologies of acute respiratory failure in patients with systemic rheumatic diseases (SRDs) requiring intensive care remain unknown. This study was undertaken to investigate the etiologies and outcomes. Methods A medical records review study was performed of 259 adult SRDs patients with respiratory failure admitted to medical ICU across a 5-year period. The etiologies were classified as infection, SRD exacerbation, and undetermined. The factors associated with ICU mortality were identified with multivariate logistic regression analysis. Results The etiologies of respiratory failure included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). The ICU mortality rate was 59.8%. A high acute physiology and chronic health evaluation II score (OR 1.118, 95% CI 1.054 to 1.186, p < 0.001), a PaO2/FiO2 ratio < 100 mmHg (OR 3.918, 95% CI 2.199 to 6.892, p < 0.001), and a diagnosis of dermatomyositis/polymyositis (OR 4.898, 95% CI 1.949 to 12.309, p = 0.001), vasculitis (OR 3.007, 95% CI 1.237 to 7.309, p = 0.015), and Pneumocystis pneumonia (OR 2.345, 95% CI 1.168 to 4.705, p = 0.016) were associated with increased mortality. Conclusions Opportunistic infections and SRD exacerbation were the most common etiologies of acute respiratory failure in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this population might help initiate definitive therapy and improve clinical outcome. Key Points • Infections, especially with opportunistic infections, were the leading cause of acute respiratory failure in critically ill rheumatology patients, with high mortality. • Severity of illness, certain types of rheumatic diseases, and opportunistic fungal infections were associated with increased mortality. • Using a comprehensive diagnostic workup might help to confirm the infective etiology and improve outcome.
Keywords Acute respiratory failure . Etiology . Infection . Systemic rheumatic disease
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05080-w) contains supplementary material, which is available to authorized users. * Jin-Min Peng [email protected] 1
Department of Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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