Interstitial Lung Disease Worsens Short- and Long-Term Outcomes of Systemic Rheumatic Disease Patients Admitted to the ICU: A Multicenter Study

Lorrain Banuls; Juliette Vanoverschelde; Fanny Garnier; Matthieu Amalric; Samir Jaber; Jonathan Charbit; Kevin Chalard; Marc Mourad; Nacim Benchabane; Racim Benomar; Noemie Besnard; Delphine Daubin; Vincent Brunot; Kada Klouche; Romaric Larcher

doi:10.3390/jcm10051037

Interstitial Lung Disease Worsens Short- and Long-Term Outcomes of Systemic Rheumatic Disease Patients Admitted to the ICU: A Multicenter Study

J Clin Med. 2021 Mar 3;10(5):1037. doi: 10.3390/jcm10051037.

Authors

Lorrain Banuls¹, Juliette Vanoverschelde², Fanny Garnier¹, Matthieu Amalric¹, Samir Jaber^{3

4}, Jonathan Charbit⁵, Kevin Chalard⁶, Marc Mourad^{4

7}, Nacim Benchabane^{1

4}, Racim Benomar¹, Noemie Besnard¹, Delphine Daubin¹, Vincent Brunot¹, Kada Klouche^{1

4}, Romaric Larcher^{1

4}

Affiliations

¹ Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France.
² Radiology Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 34090 Montpellier, France.
³ Department of Anesthesiology and Critical Care, Saint Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France.
⁴ PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France.
⁵ Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier University Hospital, 34090 Montpellier, France.
⁶ Department of Anesthesiology and Critical Care, Gui de Chauliac Hospital, Montpellier University Hospital, 34090 Montpellier, France.
⁷ Department of Anesthesiology and Critical Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 34090 Montpellier, France.

Abstract

Critically ill patients with systemic rheumatic diseases (SRDs) have a fair prognosis, while those with interstitial lung disease (ILD) have a poorer outcome. However, the prognosis of SRD patients with ILD admitted to the intensive care unit (ICU) remains unclear. We conducted a case-control study to investigate the outcomes of critically ill SRD-ILD patients. Consecutive SRD-ILD patients admitted to five ICUs from January 2007 to December 2017 were compared to SRD patients without ILD. Mortality rates were compared between groups, and prognostic factors were then identified. One hundred and forty critically ill SRD patients were included in the study. Among the 70 patients with SRD-ILD, the SRDs were connective tissue diseases (56%), vasculitis (29%), sarcoidosis (13%), and spondylarthritis (3%). Patients were mainly admitted for acute exacerbation of SRD-ILD (36%) or infection (34%). ICU, in-hospital, and one-year mortality rates in SRD-ILD patients were higher than in SRD patients without ILD (n = 70): 40% vs. 16% (p < 0.01), 49% vs. 19% (p < 0.01), and 66% vs. 40% (p < 0.01), respectively. Hypoxemia, high sequential organ failure assessment (SOFA) score, and admission for ILD acute exacerbation were associated with ICU mortality. In conclusion, ILD worsened the outcomes of SRD patients admitted to the ICU. Admissions related to SRD-ILD acute exacerbation and the severity of the acute respiratory failure were associated with ICU mortality.

Keywords: intensive care unit; interstitial lung disease; mortality; outcome; systemic rheumatic disease.