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Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients

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Abstract

Objective

The etiologies of acute respiratory failure in patients with systemic rheumatic diseases (SRDs) requiring intensive care remain unknown. This study was undertaken to investigate the etiologies and outcomes.

Methods

A medical records review study was performed of 259 adult SRDs patients with respiratory failure admitted to medical ICU across a 5-year period. The etiologies were classified as infection, SRD exacerbation, and undetermined. The factors associated with ICU mortality were identified with multivariate logistic regression analysis.

Results

The etiologies of respiratory failure included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). The ICU mortality rate was 59.8%. A high acute physiology and chronic health evaluation II score (OR 1.118, 95% CI 1.054 to 1.186, p < 0.001), a PaO2/FiO2 ratio < 100 mmHg (OR 3.918, 95% CI 2.199 to 6.892, p < 0.001), and a diagnosis of dermatomyositis/polymyositis (OR 4.898, 95% CI 1.949 to 12.309, p = 0.001), vasculitis (OR 3.007, 95% CI 1.237 to 7.309, p = 0.015), and Pneumocystis pneumonia (OR 2.345, 95% CI 1.168 to 4.705, p = 0.016) were associated with increased mortality.

Conclusions

Opportunistic infections and SRD exacerbation were the most common etiologies of acute respiratory failure in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this population might help initiate definitive therapy and improve clinical outcome.

Key Points

• Infections, especially with opportunistic infections, were the leading cause of acute respiratory failure in critically ill rheumatology patients, with high mortality.

• Severity of illness, certain types of rheumatic diseases, and opportunistic fungal infections were associated with increased mortality.

• Using a comprehensive diagnostic workup might help to confirm the infective etiology and improve outcome.

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Data availability

All data supporting the conclusions of this article are included in this article and its supplementary file.

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Funding

This work was supported by the Clinical Research Special Fund of Wu Jieping Medical Foundation [grant number 320.6750.18428 to Y.S.] and CAMS Innovation Fund for Medical Sciences (CIFMS) from Chinese Academy of Medical Sciences [grant number 2016-I2 M-1-014 to B.D.]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

    Yan Shi, Bin Du, Han-Yu Qin, Xiao-Yun Hu, Wei Jiang, Chun-Yao Wang, Li Weng & Jin-Min Peng

  2. Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

    Jiu-Liang Zhao, Qian Wang & Xiao-Feng Zeng

Authors
  1. Yan Shi
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  2. Bin Du
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  3. Jiu-Liang Zhao
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  4. Han-Yu Qin
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  6. Wei Jiang
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  7. Chun-Yao Wang
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  8. Li Weng
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  9. Qian Wang
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  10. Xiao-Feng Zeng
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  11. Jin-Min Peng
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yan Shi, Jiu-liang Zhao, Bin Du, and Jin-min Peng. The first draft of the manuscript was written by Yan Shi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jin-Min Peng.

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This study has been approved by the ethics committee of Peking Union Medical College Hospital. Given the retrospective design, informed consent was waived.

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Shi, Y., Du, B., Zhao, JL. et al. Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients. Clin Rheumatol 39, 3479–3488 (2020). https://doi.org/10.1007/s10067-020-05080-w

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