Reasons for ICU admissions and mortality in systemic lupus erythematosus in a South Indian tertiary centre - An observational study

Abstract

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease; the course of illness is interspersed with disease flares, infections, adverse drug events which may at times warrant intensive care admission. Reasons for admission and mortality predictors in intensive care units (ICUs) differ globally. This study offers a regional perspective by examining these factors in an Indian context.

Methods

This is a single centre ambispective observational study from a tertiary care hospital in South India. Patients with SLE admitted to ICU due to any cause between 2015 and 2021 were included. The primary objective was to describe reasons for admission to ICU among patients with SLE and secondary objectives were to determine short term mortality rate and factors predicting mortality. Patients’ baseline disease characteristics, reason for current hospitalization and final outcome of mortality or discharge from hospital were studied from medical records. Descriptive statistics were used and logistic regression was used to predict in-hospital mortality with different variables.

Results

Eighty-seven patients were included in the study. The mean age was 33.16 ± 12.6 years and 87% were female. The most common causes for admission were high disease activity with infection (48%) and high disease activity alone (39%). Mean APACHE II and SLEDAI-2K scores at admission were 17.32 ± 6.42 and 15.16 ± 8.3, respectively. The mean duration of ICU stay was 6.02 ± 6.58 days. The overall mortality rate was 29% with infection and disease activity being major contributors. In the multivariate model excluding cardiac arrest, APACHE II score (OR 1.56, 95% CI: 1.14–2.17, p = 0.010), RRT (OR 7.41, 95% CI: 2.86–20.00, p < 0.001), and lactate (OR 1.06, 95% CI: 1.01–1.10, p = 0.009) emerged as independent predictors of mortality.

Conclusion

The leading cause of admission to ICU in our cohort was high disease activity with or without concomitant infection. The mortality rate in our study population was 29%, which is in line with the observed trend in the last 2 decades. APACHE II score at presentation, need for RRT, and baseline serum lactate emerged as independent predictors of ICU mortality.