Study of critically ill patients with systemic lupus erythematosus in a Brazilian university hospital intensive care unit

Objective

To describe the features and outcome of patients with systemic lupus erythematosus (SLE) admitted to the ICU in a teaching hospital.

Methods

From November 2003 to October 2006, 1,052 patients were admitted to the ICU. Fifty patients had SLE and were included in this retrospective study. We analyzed demography parameters, the time of diagnosis of SLE, the cause of ICU admission, the length of stay in the hospital, the complete blood count, PaO₂/FiO₂(ratio of arterial oxygen tension to inspired oxygen concentration), the need for intensive care therapies (mechanical ventilation, dialysis, blood products, vasopressor/inotropic support), the length of stay in the ICU, outcome (survivors and nonsurvivors) and readmission to the ICU. We also evaluated the Systemic Lupus Erythematosus Disease Activity (SLEDAI) score, APACHE II (Acute Physiology and Chronic Health Evaluation II) score and standardized mortality ratio (SMR).

Results

Of the 50 patients with SLE admitted to the ICU, 88.2% were female. The mean age was 30.29 ± 12.79 years. The median time of diagnosis of SLE was 67 months. The most common organ involvements were renal (70.6%), cardiologic (61.8%), respiratory (55.9%) and neurologic (55.9%). The main reasons for admission to the ICU were respiratory (38.2%), cardiologic (29.4%) and neurologic (29.4%) dysfunctions. The median length of stay in the hospital, before admission to the ICU, was 5 days. Among the intensive care therapies, 44.1% of the patients needed blood products, 41.2% vasopressor support, 35.3% mechanical ventilation, 23.5% dialysis, and 5.9% inotropic support. The median length of stay in the ICU was 3 days. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.29 ± 6.77, with a calculated mortality rate of 37.6%. The real mortality rate in the ICU was 29.4%, with 8.8% before 48 hours. The SMR was 0.78. Between the patients who were discharged from the ICU, 30.3% were readmitted, with 3% before 48 hours. The patients with an APACHE II score >18, more than three acute organ involvements, leucopenia (<4,000 cells/mm³) and gastrointestinal or metabolic involvement had higher mortality in the ICU.

Conclusion

Despite the severity of patients with SLE at admission to the ICU (demonstrated by APACHE II score and the acute dysfunctions), they had benefit, as expressed by the SMR.