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01-11-2020 | Vasculitis | 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

Authors: Yan Shi, Bin Du, Jiu-Liang Zhao, Han-Yu Qin, Xiao-Yun Hu, Wei Jiang, Chun-Yao Wang, Li Weng, Qian Wang, Xiao-Feng Zeng, Jin-Min Peng

Published in: Clinical Rheumatology | Issue 11/2020

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.

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Title: Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients
Authors: Yan Shi
Bin Du
Jiu-Liang Zhao
Han-Yu Qin
Xiao-Yun Hu
Wei Jiang
Chun-Yao Wang
Li Weng
Qian Wang
Xiao-Feng Zeng
Jin-Min Peng
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Vasculitis
Vasculitis
Care
Pneumonia
Published in: Clinical Rheumatology / Issue 11/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-05080-w

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Results

Conclusions

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