In-ICU-acquired infections in flare-up systemic rheumatic disease patients receiving immunosuppressant.
Clin Rheumatol
; 41(9): 2845-2854, 2022 Sep.
Article
em En
| MEDLINE
| ID: mdl-35534696
ABSTRACT
OBJECTIVES:
Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can need intensive care unit (ICU) admission during a flare-up, requiring administration of immunosuppressants. We undertook this study to determine the frequency, outcome, and occurrence associated factors of infections in flare-up SRD patients receiving immunosuppressant.METHODS:
Monocenter, a retrospective study including SRD patients admitted to ICU for a flare-up requiring immunosuppressant from 2004 to 2019. The primary endpoint was in-ICU-acquired infections.RESULTS:
Ninety-eight patients (female/male ratio 1.6; mean age at admission 39.5 ± 17.4 years) were admitted to the ICU for a SRD flare-up, inaugural in 61.2% cases. A specific treatment was given to every patient corticosteroids 100%, cyclophosphamide 45.9%, plasma exchange 46.9%. Ninety-five infections occurred in 35 (36%) patients mainly pneumonias. The overall in-hospital mortality was 17.3%, and 46% of patients with a nosocomial infection died during their ICU stay. The logistic regression multivariable model retained renal replacement therapy and mechanical ventilation as independent predictors of infection.CONCLUSION:
In-ICU-acquired infection in SRD flare-up is a frequent event associated with organ failures but not with in-ICU use of immunosuppressants. These data suggest that the fear of infection should not withhold a careful in-ICU use of immunosuppressive drugs. Key Points ⢠In-ICU infections are frequent in flare-up systemic rheumatic disease patients. ⢠Infections are associated with increased mortality. ⢠Cyclophosphamide given in ICU was not independently associated with infection. ⢠Severe neutropenia occurred in 27% of patients receiving cyclophosphamide in ICU.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Doenças Reumáticas
/
Imunossupressores
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article