OUTCOME FOR PATIENTS WITH SYSTEMIC RHEUMA TIC DISEASE DIAGNOSED IN MEDICAL INTENSIVE-CARE UNITS

Objectives: The aims of this study were to evaluate the prognosis of p atients with systemic rheumatic disease diagnosed in medical intensive care unit (MICU) and to determine whether the outcome is different fo r patients with systemic rheumatic disease previously known hospitaliz ed in MICU, Methods: Retrospective evaluation, over a ten-year period, of 88 cases of systemic rheumatic disease selected in two groups: gro up I: diagnosed in MICU, group II: previously known and treated, Resul ts: Group I: 18 patients with necrotizing vasculitis (n=6), extra-inte stinal manifestations of inflammatory bowel disease (n=4), systemic lu pus erythematosus (n=3), miscellaneous (n=5), Group II: 70 patients wi th rheumatoid arthritis (n=31), necrotizing vasculitis (n=12), systemi c lupus erythematosus (n=12), polymyositis (n=4), extra-intestinal man ifestations of inflammatory bowel disease (n=5), miscellaneous (n=6), The main admission diagnoses were infectious diseases (p < 0.005) or i atrogenic complications in the group II (p < 0.01) and acute exacerbat ion of systemic rheumatic disease in the group I (p < 0.0001), Age; si mplified acute physiologic score (SAPS); number of acute organ system failure; number of patients requiring mechanical ventilation, haemodia lysis or right heart catheterization were not different between the tw o groups, The durations of mechanical ventilation and stay in the MICU were shorter in the group II (p < 0.005), MICU mortality rate was hig her in the group II (p < 0.05), with a five years cumulative proportio n of surviving statistically lower (p < 0.05), Mortality rate of the e ntire population (37.5 %) was similar to that of a non-selected popula tion with comparable SAPS, Multivariate analysis showed that SAPS, num ber of acute organ system failure and iatrogenic complications were th e main prognostic factors (p = 0.05). Conclusions: The prognosis was b etter for patients with systemic rheumatic disease diagnosed in MICU, Infectious diseases were the main cause of death, probably in relation with immunosuppressive treatments.