Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units
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BMC Rheumatology
RESEARCH ARTICLE
Open Access
Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units Toshifumi Fujiwara1,2* , Kentaro Tokuda3, Kenta Momii1,2, Kyohei Shiomoto1, Hidetoshi Tsushima1, Yukio Akasaki1, Satoshi Ikemura1, Jun-ichi Fukushi1, Jun Maki3, Noriyuki Kaku2, Tomohiko Akahoshi2, Tomoaki Taguchi2,3 and Yasuharu Nakashima1
Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU. Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PTINR were associated with a higher risk of mortality after ICU admission. Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU. Keywords: Rheumatoid arthritis, Prognostic factor, Intensive care unit, Comorbidity, APACHE II, Coagulation abnormality
* Correspondence: [email protected] 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture 812-8582, Japan 2 Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provi
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