Systemic lupus erythematosus in the intensive care unit: a systematic review

Lupus. 2020 Oct;29(11):1364-1376. doi: 10.1177/0961203320941941. Epub 2020 Jul 28.

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%-78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.

Keywords: Systemic lupus erythematosus; critically ill; disease activity; immunosuppressive agents; intensive care unit; mortality; patient outcomes.

Publication types

  • Systematic Review

MeSH terms

  • APACHE
  • Hospital Mortality
  • Humans
  • Infections / epidemiology
  • Intensive Care Units / statistics & numerical data
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / mortality*
  • Lupus Erythematosus, Systemic / therapy*
  • Multiple Organ Failure / epidemiology
  • Prognosis
  • Respiratory Insufficiency / epidemiology