https://doi.org/10.4081/reumatismo.2023.1563
Clinical characteristics and outcomes of patients with inflammatory and autoimmune rheumatological diseases admitted for intensive care in Colombia
Submitted: 7 February 2023
Accepted: 15 July 2023
Published: 18 September 2023
Accepted: 15 July 2023
Abstract Views: 1159
PDF: 199
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. Contemporary studies reporting outcomes of critical care in patients with inflammatory and autoimmune rheumatological diseases are scarce. This study describes 15 years of experience from 2005-2019 in a Colombian referral hospital.
Methods. This observational, descriptive, consecutive case series study was performed on adult patients with inflammatory and autoimmune rheumatic diseases who were admitted to the intensive care unit (ICU) of the San Ignacio University Hospital in Bogotá (Colombia), from January 1, 2005, to December 21, 2019. We describe the sociodemographic characteristics, admission causes and criteria, lengths of stay, immunosuppressive treatment, systemic support, and mortality.
Results. The study included 300 patients with a median age of 48 years [interquartile range (IQR) 31-62 years], predominantly female (76%). Disease exacerbations (30%), infections (17.6%), and cardiovascular diseases (15%) were the main causes of admission. Respiratory failure (23%) most commonly caused by septic shock (24%) was the principal indication for intensive care admission. The most frequent infections were community-acquired pneumonia (11.6%) and soft-tissue infections (9%). In 40.3% of patients, inotropic and vasopressor support was required. The median length of stay was 4 days (IQR 2-8), and global mortality was 21.6%.
Conclusions. Rheumatic diseases in the ICU are still associated with high morbidity and mortality. Patients with inflammatory and autoimmune rheumatic diseases require a meticulous clinical approach, strict clinical monitoring, frequent assessment of complications, evaluation of systemic support needs, and specific management.
Londoño J, Peláez Ballestas I, Cuervo F, Angarita I, Giraldo R, Rueda JC, et al. Prevalence of rheumatic disease in Colombia according to the Colombian Rheumatology Association (COPCORD) strategy. Prevalence study of rheumatic disease in Colombian population older than 18 years. Rev Colomb Reumatol 2018; 25: 245-56.
DOI: https://doi.org/10.1016/j.rcreue.2018.08.003
Cooper GS, Bynum MLK, Somers EC. Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmun 2009; 33: 197-207.
DOI: https://doi.org/10.1016/j.jaut.2009.09.008
Tak PP, Kalden JR. Advances in rheumatology: new targeted therapeutics. Arthritis Res Ther 2011; 13: S5.
DOI: https://doi.org/10.1186/1478-6354-13-S1-S5
Heijnen T, Wilmer A, Blockmans D, Henckaerts L. 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 2016; 45: 146-50.
DOI: https://doi.org/10.3109/03009742.2015.1067329
Mustafa M, Gladston Chelliah E, Hughes M. Patients with systemic rheumatic diseases admitted to the intensive care unit: what the rheumatologist needs to know. Rheumatol Int 2018; 38: 1163-8.
DOI: https://doi.org/10.1007/s00296-018-4008-2
Moreels M, Mélot C, Leeman M. Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive Care Med 2005; 31: 591-3.
DOI: https://doi.org/10.1007/s00134-005-2563-y
Pourrat O, Bureau JM, Hira M, Barbaz-Martin F, Descamps JM, Robert R. Outcome of patients with systemic rheumatic diseases admitted to intensive care units: a retrospective study of 33 cases. Rev Med Interne 2000; 21: 147-51.
DOI: https://doi.org/10.1016/S0248-8663(00)88243-0
Antón JM, Castro P, Espinosa G, Marcos M, Gandía M, Merchán R, 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: 338-44.
Bernal-Macías S, Reyes-Beltrán B, Molano-González N, Augusto Vega D, Bichernall C, Díaz LA, et al. Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis. Lupus Sci Med 2015; 2: e000122.
DOI: https://doi.org/10.1136/lupus-2015-000122
Camargo JF, Tobón GJ, Fonseca N, Diaz JL, Uribe M, Molina F, et al. Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature. Lupus 2005; 14: 315-20
DOI: https://doi.org/10.1191/0961203305lu2082oa
Cavallasca J, Maliandi MDR, Sarquis S, Nishishinya MB, Schvartz A, Capdevila A, et al. Outcome of patients with systemic rheumatic diseases admitted to a medical intensive care unit. J Clin Rheumatol 2010; 16: 400-2.
DOI: https://doi.org/10.1097/RHU.0b013e3181ffe517
Brünnler T, Susewind M, Hoffmann U, Rockmann F, Ehrenstein B, Fleck M. Outcomes and prognostic factors in patients with rheumatologic diseases admitted to the ICU. Intern Med 2015; 54: 1981-7.
DOI: https://doi.org/10.2169/internalmedicine.54.4283
Batko B, Stajszczyk M, Świerkot J, Urbański K, Raciborski F, Jędrzejewski M, et al. Prevalence and clinical characteristics of rheumatoid arthritis in Poland: a nationwide study. Arch Med Sci 2019; 15: 134-40.
DOI: https://doi.org/10.5114/aoms.2017.71371
Canhao H, Masuko K, Nakamura H. Editorial: nutrition and metabolism in rheumatic diseases. Front Med 2019; 6: 101.
DOI: https://doi.org/10.3389/fmed.2019.00101
Beil M, Sviri S, de la Guardia V, Stav I, Ben-Chetrit E, van Heerden PV. Prognosis of patients with rheumatic diseases admitted to intensive care. Anaesth Intensive Care 2017; 45: 67-72.
DOI: https://doi.org/10.1177/0310057X1704500110
Ranzani OT, Battaini LC, Moraes CE, Prada LFL, Pinaffi JV, Giannini FP, et al. Outcomes and organ dysfunctions of critically ill patients with systemic lupus erythematosus and other systemic rheumatic diseases. Braz J Med Biol Res 2011; 44: 1184-93.
DOI: https://doi.org/10.1590/S0100-879X2011007500132
Antón JM, Castro P, Espinosa G, Marcos M, Gandía M, Merchán R, 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: 338-44.
Peschken CA, Hitchon CA, Garland A, Bernstein CN, Chen H, Fransoo R, et al. A population-based study of intensive care unit admissions in rheumatoid arthritis. J Rheumatol 2016; 43: 26-33.
DOI: https://doi.org/10.3899/jrheum.150312
Palmezano-Díaz J, Figueroa-Pineda C, Rodríguez-Amaya RM, Plazas-Rey LK. Prevalence and characterization of autoimmune diseases in patient older than 13 years in a hospital of Colombia. Med Int Méx 2018; 34: 522-35. [Article in Spanish]
Quintero OL, Rojas-Villarraga A, Mantilla RD, Anaya J-M. Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev 2013; 12: 380-95.
DOI: https://doi.org/10.1016/j.autrev.2012.06.002
Bautista-Molano W, Fernández-Avila D, Jiménez R, Cardozo R, Marín A, Soler M del P, et al. Epidemiological profile of colombian patients with rheumatoid arthritis in a specialized care clinic. Reumatología Clínica 2016; 12: 313-8. [Article in Spanish]
DOI: https://doi.org/10.1016/j.reumae.2016.07.002
Reino JG, Loza E, Andreu JL, Balsa A, Batlle E, Cañete JD, et al. Consenso SER sobre la gestión de riesgo del tratamiento con terapias biológicas en pacientes con enfermedades reumáticas. Reumatología Clínica 2011; 7: 284-98. [Article in Spanish]
DOI: https://doi.org/10.1016/j.reuma.2011.05.002
Thong BY, Tai DY, Goh SK, Johan A. An audit of patients with rheumatic disease requiring medical intensive care. Ann Acad Med Singap 2001; 30: 254-9.
Guillaume D, Claire Montlahuc, Chemam S, Dangers L, Pichereau C, et al. Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study. Chest 2015; 148: 927-35.
DOI: https://doi.org/10.1378/chest.14-3098
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77.
DOI: https://doi.org/10.1007/s00134-017-4683-6
Córdoba JP, Larrarte C, Estrada C, Fernández-Ávila DG. Therapeutic plasma exchange in rheumatic diseases: a university hospital experience. Rev Bra Reumatol Engl Ed 2017; 57: 397-402.
DOI: https://doi.org/10.1016/j.rbre.2017.01.003
How to Cite
Fernández-Ávila, D. ., Vargas-Vanegas, Ó.R. ., Galindo-Rozo, L. ., García-Peña, Á., & Muñoz-Velandia, Ó. . (2023). Clinical characteristics and outcomes of patients with inflammatory and autoimmune rheumatological diseases admitted for intensive care in Colombia. Reumatismo, 75(3). https://doi.org/10.4081/reumatismo.2023.1563
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