期刊论文详细信息
BMC Anesthesiology
Prognosis and ICU outcome of systemic vasculitis
Patrice Befort1  Philippe Corne1  Thomas Filleron5  Boris Jung3  Christian Bengler4  Olivier Jonquet1  Kada Klouche2 
[1] Department of Intensive Care Unit, Gui de Chauliac University Hospital, Montpellier, France
[2] Department of Intensive Care Unit, Lapeyronie University Hospital, 191 Avenue du Doyen G. Giraud, Montpellier 34090, France
[3] Department of Anesthesia and Intensive care, Saint Eloi University Hospital, Montpellier, France
[4] Department of Intensive Care, University Hospital, Place Professeur Robert Debré, Nîmes, France
[5] Statistics Claudius Regaud Institute, 20-24 rue du Pont Saint Pierre, Toulouse, France
关键词: BVAS;    Intensive care unit;    Mortality;    Outcome;    Vasculitis;   
Others  :  1084792
DOI  :  10.1186/1471-2253-13-27
 received in 2012-11-08, accepted in 2013-09-24,  发布年份 2013
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【 摘 要 】

Background

Systemic vasculitis may cause life threatening complications requiring admission to an intensive care unit (ICU). The aim of this study was to evaluate outcomes of systemic vasculitis patients admitted to the ICU and to identify prognosis factors.

Methods

During a ten-year period, records of 31 adult patients with systemic vasculitis admitted to ICUs (median age: 63 y.o, sex ratio M/F: 21/10, SAPS II: 40) were reviewed including clinical and biological parameters, use of mechanical ventilation, catecholamine or/and dialysis support. Mortality was assessed and data were analyzed to identify predictive factors of outcome.

Results

Causes of ICU admissions were active manifestation of vasculitis (n = 19), septic shock (n = 8) and miscellaneous (n = 4). Sixteen patients (52%) died in ICU. By univariate analysis, mortality was associated with higher SOFA (p = 0.006) and SAPS II (p = 0.004) scores. The need for a catecholamine support or/and a renal replacement therapy, and the occurrence of an ARDS significantly worsen the prognosis. By multivariate analysis, only SAPS II (Odd ratio: 1.16, 95% CI [1.01; 1.33]) and BVAS scores (Odd ratio: 1.16, 95% CI = [1.01; 1.34]) were predictive of mortality.

Conclusion

The mortality rate of severe vasculitis requiring an admission to ICU was high. High levels of SAPS II and BVAS scores at admission were predictive of mortality.

【 授权许可】

   
2013 Befort et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Mahr A, Guillevin L, Poissonnet M, Aymé S: Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener’s granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum 2004, 51(1):92-99.
  • [2]Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG, et al.: Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 1994, 37:187-192.
  • [3]Phillip R, Luqmani R: Mortality in systemic vasculitis: a systematic review. Clin Exp Rheumatol 2008, 26:94-104.
  • [4]Gayraud M, Guillevin L, le Toumelin P, Cohen P, Lhote F, Casassus P, Jarrousse B, French Vasculitis Study Group: Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss Syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum 2001, 44(3):666-675.
  • [5]Janssen NM, Karnad DR, Guntupalli KK: Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome. Crit Care Clin 2002, 18(4):729-748.
  • [6]Cruz BA, Ramanoelina J, Mahr A, Cohen P, Mouthon L, Cohen Y, Hoang P, Guillevin L: Prognosis and outcome of 26 patients with systemic necrotizing vasculitis admitted to the intensive care unit. Rheumatology 2003, 42:1183-1188.
  • [7]Khan SA, Subla MR, Behl D, Specks U, Afessa B: Outcome of patients with small-vessel vasculitis admitted to a medical ICU. Chest 2007, 131:972-976.
  • [8]Godeau B, Boudjadja A, Dhainaut JF, Schlemmer B, Chastang C, Brunet F, Le Gall JR: Short and long term outcomes for patients with systemic rheumatic diseases admitted to intensive care units: a prognostic study of 181 patients. J Rheumatol 1997, 24:1317-1323.
  • [9]Azoulay E, Adrie C, De Lassence A, Pochard F, Moreau D, Thiery G, Cheval C, Moine P, Garrouste-Orgeas M, Alberti C, et al.: Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med 2003, 31:428-432.
  • [10]Pourrat O, Bureau JM, Hira M, Martin-Barbaz F, Descamps JM, Robert R: Outcome of patients with systemic rheumatic diseases admitted to intensive care units: a retrospective study of 39 cases. Rev Med Interne 2000, 21:147-151.
  • [11]Bouachour G, Roy PM, Tirot P, Guerin O, Gouello JP, Alquier P: Prognosis of systemic diseases diagnosed in intensive care units. Presse Med 1996, 25:837-841.
  • [12]Moreels M, Mélot C, Leeman M: Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive Care Med 2005, 31:591-593.
  • [13]Frausova D, Brejnikova M, Hruskova Z, Rihova Z, Tesar V: Outcome of thirty patients with ANCA-associated renal vasculitis admitted to the intensive care unit. Ren Fail 2008, 30(9):890-895.
  • [14]Kollef M, Enzenauer R: Predicting outcome from intensive care for patients with rheumatologic diseases. J Rheumatol 1992, 10:1260-1262.
  • [15]Semple D, Keogh J, Forni , Venn R: Clinical review: vasculitis on the intensive care unit-part 2: treatment and prognosis. Crit Care 2005, 9:193-197. BioMed Central Full Text
  • [16]Le Gall JR, Lemeshow S, Saulnier F: A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993, 270:2957-2963.
  • [17]Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ Dysfunction / failure. Intensive Care Med 1996, 22:707-710.
  • [18]Bloch DA, Michel BA, Hunder GG, McShane DJ, Arend WP, Calabrese LH, Edworthy SM, Fauci AS, Fries JF, Leavitt RY, et al.: The American college of rheumatology 1990 criteria for the classification of vasculitis. Arthritis Rheum 1990, 33:1068-1073.
  • [19]Luqmani RA, Bacon PA, Moots RJ, Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, Savage C, Adu D: Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 1994, 87(11):671-678.
  • [20]Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest 1992, 101:1644-1655.
  • [21]Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994, 149:818-824.
  • [22]Gallagher H, Kwan JT, Jayne DR: Pulmonary renal syndrome: a 4-year, single-center experience. Am J Kidney Dis 2002, 39(1):42-47.
  • [23]Hruskova Z, Casian A, Konopasek P, Svobodova B, Frausova D, Lanska V, Tesar V, Jayne D: Long-term outcome of severe alveolar haemorrhage in ANCA-associated vasculitis: a retrospective cohort study. Scand J Rheumatol 2013, 42(3):211-214.
  • [24]Diaz J, Calamia KT, Lee AS: Pulmonary vasculitis in the intensive care unit. J Intensive Care Med 2011, 26(2):88-104.
  • [25]Holguin F, Ramadan B, Gal AA, Roman J: Prognostic factors for hospital mortality and ICU admission in patients with ANCA-related pulmonary vasculitis. Am J Med Sci 2008, 336(4):321-326.
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