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19-03-2020 | Rheumatology | News | Article

Predictors of mortality risk identified in rheumatology patients admitted to the ICU

Claire Barnard

medwireNews: A number of factors, including the need for mechanical ventilation, central nervous system involvement, and length of stay, are significant predictors for mortality risk among rheumatology patients admitted to intensive care units (ICU), researchers report.

The study included 80 people with autoimmune rheumatic diseases (ARD) aged an average of 48.8 years who were admitted to a US ICU between 2012 and 2018. The most common ARD in this patient population was systemic lupus erythematosus (SLE; 42.5%), followed by rheumatoid arthritis (26.3%) and vasculitis (12.6%).

Konstantinos Parperis (University of Arizona College of Medicine, Phoenix, USA) and co-researchers report in the Journal of Clinical Rheumatology that sepsis was the most frequent reason for ICU admission, affecting 31.3% of patients, with respiratory tract infections cited as the most common source of sepsis.

In all, 20% of patients died in the ICU, and the overall mortality rate after 1 year was 33%.

Using logistic regression analysis, Parperis and team found that the people who died during ICU admission were significantly more likely than those who survived to have required mechanical ventilation, with an odds ratio (OR) of 30.71.

In all, 93.75% of patients who died within 1 year of ICU admission had mechanical ventilation, compared with 32.81% of those still alive at this timepoint.

Involvement of the central nervous (OR=15.97), cardiovascular (OR=15.97), or renal (OR=4.07) systems at admission was also significantly associated with ICU mortality risk, as was vasopressor requirement (OR=11.77). Moreover, staying in the ICU for at least 4 days (OR=9.07) and having an Acute Physiology and Chronic Health Evaluation II score of at least 19 points (OR=3.56) were additional predictors of mortality risk.

Area under the receiver operating characteristic curve analysis demonstrated that the requirement of mechanical ventilation was the strongest predictor of in-hospital mortality risk, correctly distinguishing between patients who did and did not die on 80.5% of occasions.

“[W]e believe the results of our study can shed light on the reasons and predictors of mortality of patients with ARD admitted in the ICU and can help to implement strategies to prevent morbidity and mortality,” say Parperis et al.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

J Clin Rheumatol 2020; doi:10.1097/RHU.0000000000001321

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