Diffuse Alveolar Hemorrhage: A Cohort of Patients With Systemic Lupus Erythematosus
| Autor: | Gabriel J. Tobón, Víctor-Alfonso Santos, Cristian C. Aragón, David Aguirre-Valencia, Alejandra de las Salas, Raúl-Alejandro Tafúr, Jhon H Quintana, Carlos A. Cañas |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Lung Diseases Male medicine.medical_specialty Cyclophosphamide medicine.medical_treatment Hemorrhage law.invention 03 medical and health sciences 0302 clinical medicine Rheumatology law Internal medicine medicine Humans Lupus Erythematosus Systemic 030212 general & internal medicine Hypoalbuminemia skin and connective tissue diseases Retrospective Studies 030203 arthritis & rheumatology Mechanical ventilation business.industry Medical record Diffuse alveolar hemorrhage medicine.disease Intensive care unit Pulmonary Alveoli Cohort Female business Complication medicine.drug |
| Zdroj: | Journal of clinical rheumatology : practical reports on rheumaticmusculoskeletal diseases. 26(7S Suppl 2) |
| ISSN: | 1536-7355 |
| Popis: | Background/objective Diffuse alveolar hemorrhage (DAH) is an uncommon but potentially fatal complication in patients with systemic lupus erythematosus (SLE). Its prognosis and factors associated with mortality are not completely clear, although invasive mechanical ventilation (IMV), use of cyclophosphamide, a high Acute Physiology and Chronic Health Evaluation II score, and infections are associated with high mortality rates. We investigated clinical and immunologic characteristics and factors associated with mortality in a cohort of Latin American patients with SLE who developed DAH. Methods A medical records review study was conducted of patients with SLE who were admitted to the intensive care unit (ICU) with DAH between 2011 and 2018. Clinical, laboratory, and treatment variables were compared between survivors and nonsurvivors. Results A total of 17 patients with SLE presented with DAH during the study period, of whom 11 (64.70%) were women. The median age was 28 (19-38.5) years. The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) on admission to the ICU was 15.94 ± 10.07. All patients received pulse methylprednisolone and therapeutic plasma exchange, and 13 (76. %) also received cyclophosphamide. During the hospital stay, 5 patients (29.41%) died. A high SLEDAI on admission, low albumin, and days of IMV and inotropic/vasoactive support were statistically significant in comparing nonsurvivors with survivors. Other scales of disease severity commonly used in the ICU, however, were not significantly associated with a fatal outcome. Conclusions Hypoalbuminemia, longer duration of IMV or inotropic/vasoactive treatment, and a high SLEDAI are potential prognostic factors for mortality in patients with SLE and DAH admitted to the ICU. |
| Databáze: | OpenAIRE |
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