Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study.

Détails

Ressource 1Télécharger: s13613-017-0262-9.pdf (898.31 [Ko])
Etat: Serval
Version: Final published version
ID Serval
serval:BIB_9AD3A2C15EBE
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study.
Périodique
Annals of intensive care
Auteur(s)
Demiselle J., Auchabie J., Beloncle F., Gatault P., Grangé S., Du Cheyron D., Dellamonica J., Boyer S., Beauport D.T., Piquilloud L., Letheulle J., Guitton C., Chudeau N., Geri G., Fourrier F., Robert R., Guérot E., Boisramé-Helms J., Galichon P., Dequin P.F., Lautrette A., Bollaert P.E., Meziani F., Guillevin L., Lerolle N., Augusto J.F.
ISSN-L
2110-5820
Statut éditorial
Publié
Date de publication
12/2017
Peer-reviewed
Oui
Volume
7
Numéro
1
Pages
39
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce.
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.
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).
This study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.

Pubmed
Web of science
Open Access
Oui
Création de la notice
25/04/2017 18:22
Dernière modification de la notice
08/05/2019 22:35
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