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Yoğun Bakıma Yatan Sistemik Otoimmün Hastalıkları olan Hastaların Geriye Dönük İncelenmesi

Year 2022, Volume: 44 Issue: 3, 360 - 366, 14.03.2022
https://doi.org/10.20515/otd.1007882

Abstract

Sistemik otoimmün hastalıklar, yoğun bakım ünitesine kabul gerektiren hayatı tehdit eden komplikasyonlara neden olabilir. Bu komplikayonların erken tanınması hasta sonuçlarını iyileştirebilir. Bu çalışmanın amacı yoğun bakım ünitesine yatan sistemik otoimmün hastalığıolan hastaları değerlendirimek ve sonuçlara etki eden faktörleri belirlemektir. Yöntem: 2010-2020 yılları arasında 3 basamak genel yoğun bakıma yatırılan sistemik otoimmün hastalıkları olan 18 yaş üstü hastalar geriye dönük olarak incelendi. Demografik bilgileri, APACHE 2 ve SOFA skorları, yoğun bakıma yatış nedenleri, primer hastalıklarına yönelik aldıkları tedaviler, yoğun bakımda uygulanan tedaviler ve sağ kalım oranları kayıt edildi. 67 erişkin hasta çalışmaya dahil edildi. Başlıca yatış nedenlerinin enfeksiyon (n:35), olduğu görüldü. 43 hasta yoğun bakımda kaybedildi. Yoğun bakım yatışı sırasında mekanik ventilasyon ihtiyacı olması ve yatış kültürlerinde mantar üremesi olması mortalite ile ilişkilii bulunmuştur. Ek olarak yüksek hastalık skorlarınn varlığı mortalite ile ilişkilli bulunmuştur. Yoğun bakım ünitesine yatış gerektiren sistemik otoimmün hastalıkların ölüm oranı yüksektir. Ölümlerin büyük çoğunluğu immünsüpresyona bağlı enfeksiyon nedeniyle olmaktadır. Bu yönde uygulanacak tedbirler ve eğitimler ile bu ölümlerin önüne geçilebilir.

References

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  • 2. Befort P, Corne P, Filleron T, et al. Prognosis and ICU outcome of systemic vasculitis. BMC Anesthesiology. 2013 13:27.
  • 3. Janssen NM, Karnad DR, Guntupalli KK. Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome. Crit Care Clin. 2002;18:729–748.
  • 4. Camargo JF, Tobón GJ, Fonseca N, et al. Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature. Lupus. 2005;14:315–320.
  • 5. Quintero OL, Rojas-Villarrage A, Mantilla RD, et al. Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev. 2013;12:380–395.
  • 6. Cimmino MA, Massocco M, Torre M. Hospital admission for rheumatoid arthritis dwindled in Italy between 2001 and 2008. Rheumatology (Oxford). 2011;50:2140–2141. 21.
  • 7. Wludarczyk A, Polok K, Gorka J, et al. Patients with small-vessel vasculitides have the highest mortality among systemic autoimmune diseases patients treated in intensive care unit: A retrospective study with 5-year follow-up. Crit Care. 2018 Dec;48:166-171.
  • 8. Parparis K, Al-Charakh M, Nzuonkwelle S, et al. Characteristics and Outcomes Among Patients With Autoimmune Rheumatic Diseases Requiring a Higher Level of Care. J Clin Rheumatol. 2021 Oct 1;27(7):286-291.
  • 9. Anton JM, Castro P, Espinosa G, et al. Mortality and long term survival prognostic factors of patients with systemic autoimmune diseases admitted to an intensive care unit: a retrospective study. Clin Exp Rheumatol.2012; 30:338–344.
  • 10. Heijnen T, Wilmer A, Blockmans D, et al. Outcome ofpatients with systemic diseases admitted to the medical intensive care unit of a tertiary referral hospital: a single-centre retrospective study. Scand JRheumatol. 2016;45:146–150. 22.
  • 11. Polok K, Włudarczyk A, Szczeklik W. Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage-an observational retrospective cohort study. Anaesthesiol Intensive Ther. 2019 (51, 2) 96–101.
  • 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. 19.
  • 13. Bernal-Macias S, Reyes-Beltran B, Molano-Gonzalez N, et al. Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis. Lupus Sci Med. 2015;2:e000122.
  • 14. Walsch M, Merkel PA, Peh CA, et al. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. N Engl J Med. 2020;382:622-31.
  • 15. Özdemir U, Ortaç Ersoy E, Yüksel RC, et al. Value of prognostic scores in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey. Turk J Med Sci. 2020 50: 1223-1230

Retrospective Evaluation of Patients with Systemic Autoimmune Diseases Admitted to Intensive Care

Year 2022, Volume: 44 Issue: 3, 360 - 366, 14.03.2022
https://doi.org/10.20515/otd.1007882

Abstract

Introduction: Systemic autoimmune diseases can cause life-threatening complications that require admission to the intensive care unit. Early recognition of these complications can improve patient outcomes. The aim of this study is to evaluate patients with systemic autoimmune diseases hospitalized in the intensive care unit and identify the factors affecting the patient outcomes.
Methods: Patients (aged > 18) with systemic autoimmune diseases who were hospitalized in a tertiary general intensive care unit between 2010 and 2020 were retrospectively analyzed. Demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, reasons for admission to the intensive care unit, information on treatments for primary diseases and those administered in the intensive care unit, and survival rates were recorded.
Results: The study included 67 adult patients. The main reason for hospitalization was infection (n = 35), and 43 patients died in the intensive care unit. The need for mechanical ventilation during intensive care hospitalization and the presence of fungal infection as per fungal cultures performed at hospitalization were found to be associated with mortality. In addition, the presence of high disease severity scores was associated with mortality.
Conclusion: The mortality rate of patients with systemic autoimmune diseases requiring intensive care unit admission was found to be high. The majority of deaths occurred as a result of infections associated with immunosuppression. Such deaths can be prevented by implementing specific measures and conducting training targeting these issues.

References

  • 1. Heijnen T, Wilmer A, Blockmans D, et al. Outcome of patients with systemic diseases admitted to the medical intensive care unit of a tertiary referral hospital: a single-centre retrospective study. Scand J Rheumatol. 2015;1–5
  • 2. Befort P, Corne P, Filleron T, et al. Prognosis and ICU outcome of systemic vasculitis. BMC Anesthesiology. 2013 13:27.
  • 3. Janssen NM, Karnad DR, Guntupalli KK. Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome. Crit Care Clin. 2002;18:729–748.
  • 4. Camargo JF, Tobón GJ, Fonseca N, et al. Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature. Lupus. 2005;14:315–320.
  • 5. Quintero OL, Rojas-Villarrage A, Mantilla RD, et al. Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev. 2013;12:380–395.
  • 6. Cimmino MA, Massocco M, Torre M. Hospital admission for rheumatoid arthritis dwindled in Italy between 2001 and 2008. Rheumatology (Oxford). 2011;50:2140–2141. 21.
  • 7. Wludarczyk A, Polok K, Gorka J, et al. Patients with small-vessel vasculitides have the highest mortality among systemic autoimmune diseases patients treated in intensive care unit: A retrospective study with 5-year follow-up. Crit Care. 2018 Dec;48:166-171.
  • 8. Parparis K, Al-Charakh M, Nzuonkwelle S, et al. Characteristics and Outcomes Among Patients With Autoimmune Rheumatic Diseases Requiring a Higher Level of Care. J Clin Rheumatol. 2021 Oct 1;27(7):286-291.
  • 9. Anton JM, Castro P, Espinosa G, et al. Mortality and long term survival prognostic factors of patients with systemic autoimmune diseases admitted to an intensive care unit: a retrospective study. Clin Exp Rheumatol.2012; 30:338–344.
  • 10. Heijnen T, Wilmer A, Blockmans D, et al. Outcome ofpatients with systemic diseases admitted to the medical intensive care unit of a tertiary referral hospital: a single-centre retrospective study. Scand JRheumatol. 2016;45:146–150. 22.
  • 11. Polok K, Włudarczyk A, Szczeklik W. Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage-an observational retrospective cohort study. Anaesthesiol Intensive Ther. 2019 (51, 2) 96–101.
  • 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. 19.
  • 13. Bernal-Macias S, Reyes-Beltran B, Molano-Gonzalez N, et al. Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis. Lupus Sci Med. 2015;2:e000122.
  • 14. Walsch M, Merkel PA, Peh CA, et al. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. N Engl J Med. 2020;382:622-31.
  • 15. Özdemir U, Ortaç Ersoy E, Yüksel RC, et al. Value of prognostic scores in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey. Turk J Med Sci. 2020 50: 1223-1230
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Ebru Karakoç 0000-0002-2995-5893

İlkay Ceylan 0000-0003-3306-3107

Meryem Onay 0000-0002-5028-9135

Birgül Yelken 0000-0001-9677-9028

Publication Date March 14, 2022
Published in Issue Year 2022 Volume: 44 Issue: 3

Cite

Vancouver Karakoç E, Ceylan İ, Onay M, Yelken B. Retrospective Evaluation of Patients with Systemic Autoimmune Diseases Admitted to Intensive Care. Osmangazi Tıp Dergisi. 2022;44(3):360-6.


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