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Clinical Rheumatology

, Volume 38, Issue 11, pp 3015–3023 | Cite as

Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study

  • Yael Haviv-Yadid
  • Yulia Segal
  • Amir Dagan
  • Kassem Sharif
  • Nicola Luigi Bragazzi
  • Abdulla Watad
  • Howard Amital
  • Yehuda Shoenfeld
  • Ora ShovmanEmail author
Original Article
  • 78 Downloads

Abstract

Background

Patients with rheumatoid arthritis (RA) are at a high risk for life-threatening conditions requiring admission to the intensive care unit (ICU), but the data regarding the outcomes of these patients is limited. The present study investigated the clinical characteristics and outcomes of RA patients admitted to an ICU.

Methods

This retrospective cohort study included RA patients admitted to the general ICU of the Sheba Medical Center during 2002–2018. The main outcome was 30-day mortality. Using Student’s t test, χ2, and multivariable analyses, we compared the demographic, clinical, and laboratory parameters of the survivors and the non-survivors. Figures with p value < 0.05 were considered statistically significant.

Results

Forty-three RA patients were admitted to the ICU during the study period (mean age, 64.0 ± 13.1 years; 74.4% female). The leading causes of ICU admission were infection (72.1%), respiratory failure (72.1%), renal failure (60.5%), and septic shock (55.8%). The 30-day mortality rate was 34.9%, with infection (9/15, 60%) as the most frequent cause. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were 19.7 ± 12.5 and 7.0 ± 4.5, respectively. Multivariable analysis showed that heart failure (p = 0.023), liver failure (p = 0.012), SOFA score (p = 0.007), and vasopressor treatment in ICU (p = 0.039) were significantly associated with overall mortality. SOFA score was linked with overall mortality (area under the curve (AUC) = 0.781 ± 0.085, p = 0.003) and mortality from respiratory failure (AUC = 0.861 ± 0.075, p = 0.002), while APACHE II score was only correlated with mortality from infection (AUC = 0.735 ± 0.082, p = 0.032).

Conclusions

Our study demonstrated a relatively high mortality rate among RA patients who were admitted to the general ICU. RA patients with risk factors such as heart failure, liver failure, elevated SOFA score, and vasopressor treatment in ICU should be promptly identified and treated accordingly.

Key Points

• The 30-day mortality rate of patients with RA that were admitted to the general ICU of a tertiary hospital was 34.9%.

• The most common causes of ICU admission among patients with RA were infections and respiratory failure. Infections were the most common cause of death among these patients.

• Patients with RA that present to the ICU with heart failure, liver failure, elevated SOFA score, and/or require vasopressor treatment in ICU should be promptly identified and treated accordingly.

Keywords

Acute physiology and chronic health evaluation (APACHE) II score Intensive care unit Rheumatoid arthritis mortality Sequential organ failure assessment (SOFA) score 

Notes

Compliance with ethical standards

The study fulfilled the ethical guidelines of the most recent declaration of Helsinki (Edinburgh, 2000) and received approval (No. 3233-16-SMC) by the local ethical committee.

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Intensive Care UnitSheba Medical CenterRamat GanIsrael
  2. 2.Department of Internal Medicine ‘T’Sheba Medical CenterRamat GanIsrael
  3. 3.Department of Internal Medicine ‘B’Assuta Ashdod Medical CenterAshdodIsrael
  4. 4.Rheumatology UnitAssuta Ashdod Medical CenterAshdodIsrael
  5. 5.Ben-Gurion University of the NegevBeer ShevaIsrael
  6. 6.Department of Internal Medicine ‘B’Sheba Medical CenterRamat GanIsrael
  7. 7.School of Public Health, Department of Health Sciences (DISSAL)University of GenoaGenoaItaly
  8. 8.Zabludowicz Center for Autoimmune DiseasesSheba Medical CenterRamat GanIsrael
  9. 9.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  10. 10.Past incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune DiseasesTel Aviv UniversityTel AvivIsrael
  11. 11.I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)MoscowRussia

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