A study of Thai patients with systemic lupus erythematosus in the medical intensive care unit: epidemiology and predictors of mortality

In this retrospective study, we described demographic information, reasons for admission, APACHE II severity scores, complications, mortality rate, causes of death and prognostic factors in 61 Thai patients with systemic lupus erythematosus (SLE) who were admitted to the medical intensive care unit (ICU) over a six-year period. The overall mortality rate during ICU hospitalization was 57% and the most common cause of death was infection, especially in the lower respiratory tract. The mean (SD) APACHE II score was 24.8 (10.8). SLE patients who had an APACHE II score of 20 or more were up to 65% of the patient population and had a significantly lower probability of survival based on Kaplan-Meier results (p=0.004). The need for vasopressor therapy was significantly higher in patients who did not survive (OR=6.98, 95% CI=1.91-25.49). The patients who developed ventilator-associated pneumonia had a numerically higher mortality, which was not statistically significant (OR=4.17, 95% CI=0.91-19.03). The use of azathioprine as a steroid-sparing agent for SLE was associated with lower mortality rates (OR=0.08, 95% CI=0.01-0.58). Our findings emphasize that Thai SLE patients admitted to the medical ICU has a high mortality rate and early aggressive treatments are warranted.