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Study of critically ill patients with systemic lupus erythematosus

Ansell, Stephen Maxted MB BCh, PhD; Bedhesi, Sunil MB BCh, FCP; Ruff, Brian MB BCh, FCP; Mahomed, Akhter Goolam MB BCh FCP; Richards, Guy MB BCh, PhD, FCP; Mer, Mervyn MB BCh, FCP; Feldman, Charles MB BCh, PhD, FCP

Clinical Investigation

Objectives  To determine the presenting features, prognostic factors, course, and outcome of critically ill patients with systemic lupus erythematosus admitted to the intensive care unit (ICU).

Design  Retrospective patient record review.

Setting  Two academic teaching hospitals.

Patients  All patients with systemic lupus erythematosus admitted to the ICUs between January 1982 and July 1993.

Measurements and Main Results  There were 28 female and two male patients. Fifteen patients were white, 11 patients were black, and four patients were Asian. The median age was 29 yrs. The reasons for admission to the ICU were multifactorial. However, most patients were admitted for infective, renal, cardiac, or coagulation complications. Despite aggressive management, 16 (53%) patients died in the ICU or shortly after discharge. The median ICU survival rate (admission to death) was 22 days. The only pretreatment factor that predicted a poor outcome was the presence of renal involvement due to systemic lupus erythematosus.

Conclusions  Our study suggests that patients with systemic lupus erythematosus admitted to an ICU often have florid disease manifestations with multifactorial reasons precipitating the admission. The prognosis for such patients is poor, particularly in the presence of renal involvement.

(Crit Care Med 1996; 24:981-984)

From the Department of Medicine, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa.

Address requests for reprints to: Dr. Charles Feldman, Department of Medicine, University of Witwatersrand Medical School, York Road, Parktown 2193, Johannesburg, Republic of South Africa.

© Williams & Wilkins 1996. All Rights Reserved.