Skip to main content

Advertisement

SpringerLink
Log in

Severe pneumonia in patients with systemic lupus erythematosus admitted to the intensive care unit

Schwere Pneumonie bei Intensivpatienten mit systemischem Lupus erythematosus

  • Originalien
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to investigate clinical characters and prognosis of patients with systemic lupus erythematosus (SLE) and severe pneumonia admitted to the intensive care unit (ICU).

Materials and methods

We conducted a retrospective study that reviewed all clinical records of patients with SLE and severe pneumonia admitted to the ICU between 2008 and 2020.

Results

A total of 86 SLE patients with severe pneumonia during their first ICU admission were enrolled in this study. Most patients were female (n = 71, 82.5%), and the median age was 42.3 ± 14.7 years. The most common organisms were gram-positive bacteria (20.9%), followed by gram-negative bacteria (18.6%) and fungi (10.4%). A total of 31 patients died within 30 days of ICU admission, and the 30-day mortality was 36%. In binary logistic regression analysis, Acute Physiologic and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score and mechanical ventilation were dependently associated with 30-day mortality (odds ratio [OR] 2.97, P = 0.016; OR = 4.02, P = 0.023; OR = 1.52, P = 0.036; respectively). Among the other 55 patients, 5 patients died after discharge from the ICU during the long-term follow-up.

Conclusions

Mortality was high in SLE patients with severe pneumonia admitted to the ICU, and most of the patients died within 30 days of ICU admission.

Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, die klinischen Merkmale und die Prognose von auf die Intensivstation aufgenommenen Patienten mit systemischem Lupus erythematosus (SLE) und schwerer Pneumonie zu untersuchen.

Material und Methoden

Dazu wurde eine retrospektive Studie durchgeführt, in der sämtliche klinischen Aufzeichnungen von Patienten mit SLE und schwerer Pneumonie, die zwischen 2008 und 2020 auf der Intensivstation behandelt worden waren, ausgewertet wurden.

Ergebnisse

In die Studie aufgenommen wurden 86 SLE-Patienten mit schwerer Pneumonie während ihrer ersten Aufnahme auf die Intensivstation. Die meisten waren Frauen (n = 71; 82,5%), und das Durchschnittsalter betrug 42,3 ± 14,7 Jahre. Als häufigste Erreger fanden sich grampositive Bakterien (20,9%), gramnegative Bakterien (18,6%) und Pilze (10,4%). Innerhalb von 30 Tagen nach Aufnahme auf die Intensivstation starben 31 Patienten, und die 30-Tage-Mortalität betrug 36%. In der binären logistischen Regressionsanalyse waren die Scores Acute Physiologic and Chronic Health Evaluation II (APACHE II) und Sequential Organ Failure Assessment (SOFA) sowie mechanische Beatmung in abhängiger Weise mit der 30-Tage-Mortalität verknüpft (Odds Ratio, OR: 2,97; p = 0,016; OR = 4,02; p = 0,023 bzw. OR = 1,52; p = 0,036). Von den übrigen 55 Patienten starben 5 nach Entlassung von der Intensivstation während der Langzeitnachbeobachtung.

Schlussfolgerung

Bei SLE-Patienten mit schwerer Pneumonie, die auf der Intensivstation behandelt wurden, war die Mortalität hoch, und die meisten der Patienten starben innerhalb von 30 Tagen nach Aufnahme auf die Intensivstation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kaul A, Gordon C, Crow MK et al (2016) Systemic lupus erythematosus. Nat Rev Dis Primers 2:16039

    Article  PubMed  Google Scholar 

  2. Tselios K, Gladman DD, Sheane BJ et al (2019) All-cause, cause-specific and age-specific standardised mortality ratios of patients with systemic lupus erythematosus in Ontario, Canada over 43 years (1971–2013). Ann Rheum Dis 78:802–806

    Article  PubMed  Google Scholar 

  3. Alvarez Barreneche MF, Mcewen Tamayo WD, Montoya Roldan D et al (2019) Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia. Adv Rheumatol 59:29

    Article  PubMed  Google Scholar 

  4. Heijnen T, Wilmer A, Blockmans D et al (2016) 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 45:146–150

    Article  CAS  PubMed  Google Scholar 

  5. Carrizosa JA, Aponte J, Cartagena D et al (2017) Factors associated with mortality in patients with autoimmune diseases admitted to the intensive care unit in Bogota, Colombia. Front Immunol 8:1–6

    Article  Google Scholar 

  6. Lee J, Dhillon N, Pope J (2013) All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatology 52:905–909

    Article  PubMed  Google Scholar 

  7. Levy O, Markov A, Drob Y et al (2018) All-cause hospitalizations in systemic lupus erythematosus from a single medical center in Israel. Rheumatol Int 38:1841–1846

    Article  PubMed  Google Scholar 

  8. Quintero OL, Rojas-Villarraga A, Mantilla RD et al (2013) Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev 12:380–395

    Article  PubMed  Google Scholar 

  9. Garcia-Guevara G, Rios-Corzo R, Diaz-Mora A et al (2018) Pneumonia in patients with systemic lupus erythematosus: epidemiology, microbiology and outcomes. Lupus 27:1953–1959

    Article  CAS  PubMed  Google Scholar 

  10. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725

    Article  CAS  PubMed  Google Scholar 

  11. Mandell LA, Wunderink RG, Anzueto A et al (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44:27–72

    Article  Google Scholar 

  12. Gladman DD, Ibanez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29:288–291

    PubMed  Google Scholar 

  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE et al (1985) APACHE II: a severity of disease classifification system. Crit Care Med 13:818–829

    Article  CAS  PubMed  Google Scholar 

  14. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  CAS  PubMed  Google Scholar 

  15. Han BK, Bhatia R, Traisak P et al (2013) Clinical presentations and outcomes of systemic lupus erythematosus patients with infection admitted to the intensive care unit. Lupus 22:690–696

    Article  CAS  PubMed  Google Scholar 

  16. Zamir G, Haviv-Yadid Y, Sharif K et al (2018) Mortality of patients with systemic lupus erythematosus admitted to the intensive care unit—A retrospective single-center study. Best Pract Res Clin Rheumatol 32:701–709

    Article  PubMed  Google Scholar 

  17. Aragón CC, Ruiz-Ordoñez I, Quintana JH et al (2020) Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit. Lupus 29:1133–1139

    Article  PubMed  Google Scholar 

  18. Dumas G, Géri G, Montlahuc C et al (2015) Outcomes in critically ill patients with systemic rheumatic disease: a multicenter study. Chest 148:927–935

    Article  PubMed  Google Scholar 

  19. Narata R, Wangkaew S, Kasitanon N, Louthrenoo W (2007) Community-acquired pneumonia in Thai patients with systemic lupus erythematosus. Southeast Asian J Trop Med Public Health 38:528–536

    PubMed  Google Scholar 

  20. García-Guevara G, Ríos-Corzo R, Díaz-Mora A et al (2018) Pneumonia in patients with systemic lupus erythematosus: epidemiology, microbiology and outcomes. Lupus 27:1953–1959

    Article  PubMed  Google Scholar 

  21. Suárez-Avellaneda A, Quintana JH, Aragón CC et al (2020) Systemic lupus erythematosus in the intensive care unit: a systematic review. Lupus 29:1364–1376

    Article  PubMed  Google Scholar 

  22. Shen HN, Yang HH, Lu CL (2013) Temporal trends in characteristics and outcome of intensive care unit patients with systemic lupus erythematosus in Taiwan: a national population based study. Lupus 22:644–652

    Article  PubMed  Google Scholar 

  23. Williams FM, Chinn S, Hughes GR et al (2002) Critical illness in systemic lupus erythematosus and the antiphospholipid syndrome. Ann Rheum Dis 61:414–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Antón JM, Castro P, Espinosa G et al (2012) 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 30:338–344

    PubMed  Google Scholar 

Download references

Funding

This study was supported by the grants from the National Science Foundation of Zhejiang (LQ17H030005), the Wenzhou Committee of Science and Technology (Y2020267), and 2019 Jiaxing Key Discipiline of Medcine-Rheumatology and Autoimmunology(Supporting Subject) (2019-zc-03).

Author information

Authors and Affiliations

  1. Department of Rheumatology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, 314000, Jiaxing, Zhejiang, China

    Bin Zhang

  2. Department of Infectious Diseases, First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, Zhejiang, China

    Luzhao Zheng & Yu Huang

Authors
  1. Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luzhao Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu Huang.

Ethics declarations

Conflict of interest

B. Zhang, L. Zheng and Y. Huang declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

Redaktion

Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

figure qr

Scan QR code & read article online

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, B., Zheng, L. & Huang, Y. Severe pneumonia in patients with systemic lupus erythematosus admitted to the intensive care unit. Z Rheumatol 83 (Suppl 1), 148–153 (2024). https://doi.org/10.1007/s00393-022-01172-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-022-01172-x

Keywords

Schlüsselwörter

Search

Navigation