Characteristics and mortality of patients with rheumatologic diseases admitted at an intensive care unit of Paraguay

Abstract

Introduction: Rheumatologic diseases are not unusual in general population. This group of patients   usually requires hospitalization for various causes and up to a third of them may be admitted to the Intensive Care Unit (ICU). The prognosis can be unfavorable, especially in the presence of renal involvement. Objective: To characterize rheumatologic patients admitted to Intensive Care and determi- ne their mortality. Methods: We conducted a descriptive, retrospective cross-sectional study. Data were collec- ted from medical records of patients with rheumatic diseases admitted to the ICU of the Hospital de Clínicas from January 2021 to December 2022. Results: Twenty-nine patients with rheumatic diseases were admitted in the two years of the study. Twenty-three (79.31%) were women. The median age was 37 years (IQR 22.5). Twenty patients (68.9%) had Systemic Lupus Erythematosus, five (17.2%) rheumatoid arthri- tis and there maining four patients (3.44%) had mixed connective tissue disease, Sjogren‘s Syndrome, Overlap Syndrome and Churg Strauss Vasculitis. The most frequent comorbidi- ties were: arterial hypertension (55%) and nephropathy (41.3%). The causes of admission to the ICU were medical (62%) and surgical (38%). Between medical causes, respiratory failure was the main reason (44%), followed by shock (27%) and intercurrent infections (11.1%). The mean APACHE II (Assessment of Age and Chronic Health) score was 17 ± 10; SOFA on admission (Sequential Organ Failure Assessment): 6 ± 8.5 and the SLEDAI Scale (Systemic Lupus Erythematosus Disease Activity Measure) in lupus patients: 10.6 ± 8.3. Nineteen patients (65.5%) received mechanical ventilation (MV) with a median number of days on MV of 6 (IQR 9). Vasoactive drugs were used by 65.5% and hemodialysis by 17.2%. Methylprednisolone was administered to 10 of the patients (37.9%), in addition 4 of them required cyclophosphamide and 3 immunoglobulins. During hospitalization thirteen patients (44.8%) developed acute renal failure and twelve of them (41.3%) intercurrent in- fections; 6 of them with blood stream Gram Positive isolation. The median length of stay in the ICU was 6 days (IQR: 10) and mortality was 37.9% (eleven patients). Conclusions: In our study, the population was mainly young women with several comorbi- dities, who were admitted in serious condition to the ICU, most of them for medical reasons. Two-thirds required MV and vasoactive drugs. They presented complications such as acute renal failure and intercurrent infections. Mortality was 38%, only a little higher than that corres- ponding to the gravity score of income.