6
|
Mirouse A, Parrot A, Audigier V, Demoule A, Mayaux J, Géri G, Mariotte E, Bréchot N, de Prost N, Vautier M, Neuville M, Bigé N, de Montmollin E, Cacoub P, Resche-Rigon M, Cadranel J, Saadoun D. Severe diffuse alveolar hemorrhage related to autoimmune disease: a multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:231. [PMID: 32423434 PMCID: PMC7236262 DOI: 10.1186/s13054-020-02936-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening. The objective was to assess characteristics and prognosis factors of DAH who required intensive care unit (ICU) admission in patients with autoimmune diseases. METHODS French multicenter retrospective study including patients presenting DAH related to autoimmune diseases requiring ICU admission from 2000 to 2016. RESULTS One hundred four patients (54% of men) with median age of 56 [32-68] years were included with 79 (76%) systemic vasculitis and 25 (24%) connective tissue disorders. All patients received steroids, and 72 (69%), 12 (11.5%), and 57 (55%) patients had cyclophosphamide, rituximab, and plasma exchanges, respectively. During ICU stay, 52 (50%), 36 (35%), and 55 (53%) patients required mechanical ventilation, vasopressor use, and renal replacement therapy, respectively. Factors associated with mechanical ventilation weaning were age (HR [95%CI] 0.97 [0.96-0.99] per 10 years, p < 0.0001), vasculitis-related DAH (0.52 [0.27-0.98], p = 0.04), and time from dyspnea onset to ICU admission (0.99 [0.99-1] per day, p = 0.03). ICU mortality was 15%. Factors associated with alive status at ICU discharge were chronic cardiac failure (HR [95%CI] 0.37 [0.15-0.94], p = 0.04), antiphospholipid syndrome-related DAH (3.17 [1.89-5.32], p < 0.0001), SAPS II (0.98 [0.97-0.99], p = 0.007), and oxygen flow at ICU admission (0.95 [0.91-0.99] per liter/min, p = 0.04). CONCLUSION DAH in autoimmune diseases is a life-threatening complication which requires mechanical ventilation in half of the cases admitted to ICU.
Collapse
Affiliation(s)
- Adrien Mirouse
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,CNRS, FRE3632, 75005, Paris, France.,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Antoine Parrot
- Service de Pneumologie, Hôpital Tenon, APHP, Paris, France
| | - Vincent Audigier
- Département de Biostatistiques, Hôpital Saint-Louis, APHP, Paris, France
| | - Alexandre Demoule
- Service de Réanimation Médicale et Pneumologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Julien Mayaux
- Service de Réanimation Médicale et Pneumologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Guillaume Géri
- Service de Réanimation Médicale, Hôpital Cochin, APHP, Paris, France
| | - Eric Mariotte
- Service de Réanimation Médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Nicolas Bréchot
- Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nicolas de Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, APHP, Créteil, France
| | | | - Mathilde Neuville
- Service de Réanimation Médicale, Hôpital Bichat, APHP, Paris, France
| | - Naïke Bigé
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Etienne de Montmollin
- Service de Réanimation Medico-chirurgicale, Hôpital Delafontaine, Saint-Denis, France
| | - Patrice Cacoub
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,CNRS, FRE3632, 75005, Paris, France.,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | | | | | - David Saadoun
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France. .,INSERM, UMR_S 959, 75013, Paris, France. .,CNRS, FRE3632, 75005, Paris, France. .,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
| |
Collapse
|
12
|
Sun YS, Huang DF, Lin FC, Hsu CK, Sun IT, Chang SC, Tsai CY, Lai CC. Cytomegaloviral or Pneumocystis Jiroveci Pneumonia Increases Mortality in Systemic Lupus Erythematosus Patients with Pulmonary Hemorrhage: Evidence from Bronchoalveolar Lavage Fluid. J Rheumatol 2018; 46:251-258. [PMID: 30504509 DOI: 10.3899/jrheum.180104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the role of cytomegaloviral or Pneumocystis jiroveci pneumonia (CMV/PJP) in systemic lupus erythematosus (SLE) patients with pulmonary hemorrhage (PH). METHODS We retrospectively examined hospital records for 27 SLE patients with PH who received bronchoalveolar lavage fluid (BALF) analyses. Clinical profile and mortality rates were compared between groups with and without CMV/PJP. Risk factors for PH-related mortality were analyzed. RESULTS Among 27 SLE patients with PH, 15 had pathogens from BALF samples, and 8 had CMV/PJP. Although CMV/PJP was treated, the RR for 90- and 180-day mortality rates of SLE patients with CMV/PJP were higher than those without these infections (5.94, 95% CI 1.44-24.48; 7.13, 95% CI 1.81-28.06, respectively). Risk factors for 90- and 180-day mortality were presence of CMV/PJP (OR 14.2, 95% CI 1.83-109.9; OR 25.5, 95% CI 2.91-223.3, respectively) and use of pulse methylprednisolone for PH treatment (OR 12.0, 95% CI 1.48-97.2; OR 8.5, 95% CI 1.13-63.9, respectively). Factors increasing the 90-day mortality rate were duration of mechanical ventilation exceeding 14 days (OR 11.1, 95% CI 1.11-112.0) and use of aggressive immunosuppression close to PH onset (OR 7.56, 95% CI 1.09-52.4). Three of the 7 patients receiving aggressive immunosuppression died with the presence of CMV/PJP. CONCLUSION Owing to the high prevalence of CMV/PJP and its association with mortality, routine BALF analysis is recommended for all suitable SLE patients with PH. Use of aggressive immunosuppression does not benefit SLE patients with opportunistic infections during PH attack.
Collapse
Affiliation(s)
- Yi-Syuan Sun
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - De-Feng Huang
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Fang-Chi Lin
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chih-Kai Hsu
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - I-Ting Sun
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Shi-Chuan Chang
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chang-Youh Tsai
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chien-Chih Lai
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan. .,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University.
| |
Collapse
|