Mortality High Among Patients With SLE, Pneumonia Requiring ICU Admission

Patients with systemic lupus erythematosus (SLE) who are admitted to hospital intensive care units (ICUs) with severe pneumonia face a high risk of mortality, according to a new study—although evidence also suggests the mortality rate may be falling.

Writing in Zeitschrift für Rheumatologie, the study authors noted that despite advances in the treatment of SLE, it remains the leading cause of ICU admissions among patients with rheumatic diseases. Often, such admissions are due to disease flares, but infections are also a common reason for hospitalizations. Pulmonary infections in this patient population tend to be more frequent and more severe than in the general population, they added.

Although significant research has looked into potential causes of infection risk in patients with SLE, less attention has been paid to their prognosis from infections. The investigators therefore sought to retrospectively analyze outcomes among patients with SLE who were admitted to their own medical center’s ICU with severe pneumonia (N = 86) from 2008 to 2020. Eighty-three percent were female, and the patients had a median age of 42.3 years.

Thirty-three patients had lupus nephritis upon admission, among whom all but 6 patients had received prednisone. A total of 29 patients were given cyclophosphamide prior to admission, making it the most common immunosuppressive agent given to patients. Just over 1 in 5 patients (20.9%) had gram-positive bacteria and 18.6%)had gram-negative bacteria. In 10.4% of cases, test results were positive for fungi.

On average, patients stayed 17.9 days in the ICU. However, many patients did not recover, with 31 patients dying within 30 days of ICU admission, resulting in a 30-day mortality rate of 36%. An additional 5 patients died following discharge from the ICU or during long-term follow-up.

The study authors said their 30-day mortality rate was similar to that of other studies; however, they said there appears to be a positive trend in survival rates.

“In a large national 10-year population-based follow-up study from Taiwan conducted on 2870 patients with SLE admitted to the ICU, the mortality rate decreased from 42.6% in 1999-2000 to 31.2% in 2007-2008,” they noted, adding that a second study found an even lower mortality rate.

“These findings indicate that if the prognosis of severe pneumonia is similar to that of other conditions in SLE patients in the ICU, then the relative lower mortality rate may be the result of recent advances in diagnostic and therapeutic strategies in these patients,” they wrote.

In examining factors that appeare to increase the risk of mortality, the authors found that Acute Physiologic and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were tied with mortality risk, as was the need for mechanical ventilation—although the odds ratio for the latter was lower. In terms of SLE disease activity, the authors said disease activity index scores may be a potential risk factor for infection, but the scores do not appear to have an impact on patient prognosis.

Reference

Zhang B, Zheng L, Huang Y. Severe pneumonia in patients with systemic lupus erythematosus admitted to the intensive care unit. Z Rheumatol. Published online March 1, 20220. doi:10.1007/s00393-022-01172-x