Patients with ANCA-associated vasculitis admitted to the intensive care unit with
acute vasculitis manifestations: a retrospective and comparative multicentric
study
#MMPMID28382598
Demiselle J
; Auchabie J
; Beloncle F
; Gatault P
; Grangé S
; Du Cheyron D
; Dellamonica J
; Boyer S
; Beauport DT
; Piquilloud L
; Letheulle J
; Guitton C
; Chudeau N
; Geri G
; Fourrier F
; Robert R
; Guérot E
; Boisramé-Helms J
; Galichon P
; Dequin PF
; Lautrette A
; Bollaert PE
; Meziani F
; Guillevin L
; Lerolle N
; Augusto JF
Ann Intensive Care
2017[Dec]; 7
(1
): 39
PMID28382598
show ga
PURPOSE: Data for ANCA-associated vasculitis (AAV) patients requiring intensive
care are scarce. METHODS: We included 97 consecutive patients with acute AAV
manifestations (new onset or relapsing disease), admitted to 18 intensive care
units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV
patients with new onset or relapsing disease, admitted to two nephrology
departments with acute vasculitis manifestations, constituted the control group.
RESULTS: In the ICU group, patients predominantly showed granulomatosis with
polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU
group showed comparable Birmingham vasculitis activity score and a higher
frequency of heart, central nervous system and lungs involvements. Respiratory
assistance, renal replacement therapy and vasopressors were required in 68.0,
56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received
glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges
as remission induction regimens. Fifteen (15.5%) patients died during the ICU
stay. The following were significantly associated with ICU mortality in the
univariate analysis: the need for respiratory assistance, the use of
vasopressors, the occurrence of at least one infection event in ICU,
cyclophosphamide treatment, sequential organ failure assessment at admission and
simplified acute physiology score II. After adjustment on sequential organ
failure assessment or infection, cyclophosphamide was no longer a risk factor for
mortality. Despite a higher initial mortality rate of ICU patients within the
first hospital stay (p < 0.0001), the long-term mortality of hospital survivors
did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively,
p = 0.36). Moreover, we observed no renal survival difference between groups
after a 1-year follow-up (82.1 and 80.5%, p = 0.94). CONCLUSION: This study
supports the idea that experiencing an ICU challenge does not impact the
long-term prognosis of AAV patients.
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