Systemic lupus erythematosus reduces survival of ICU patients mediated by renal dysfunction: retrospective study of critically ill patients
Year: 2025
Type: article
Study design: Observational Study
Abstract: Systemic lupus erythematosus (SLE), an autoimmune disease, damages multiple organs. Studies showed higher all-cause mortality in SLE patients compared to the general population. However, it remains unclear whether the persistent immunodeficiency and organ damage exacerbate the prognosis of intensive care for patients with comorbid SLE. A cohort of 50,920 critically ill patients from 2008 to 2019 in USA was obtained from the MIMIC IV database. Matching was employed to create control groups, mitigating the influence of known confounders. Wilcoxon test and Pearson’s Chi-squared Test were utilized to compare quantitative and categorical variables between groups, respectively. Log-rank test was used to compare survival differences. Univariate and multivariate Cox regression analyses were conducted to explore influencing factors. Mediation analysis was employed to investigate the mediating role of influencing factors. Patients with comorbid SLE showed notably lower 180-day survival than controls (HR = 1.485, P = 0.015). While hemoglobin, platelets, white blood cells, creatinine, urine output, SOFA performed significance in univariate Cox regression analysis, only creatinine and urine output remained significant in multivariate analysis. Mediation analysis revealed the significant mediating effect of renal function (represented by creatinine). SLE patients treated with glucocorticoids did not exhibit a significant decrease in survival compared to controls (HR = 1.482, P = 0.095), whereas those without glucocorticoids showed a significant decrease (HR = 1.660, P = 0.027). SLE diminishes survival among critically ill patients by affecting renal function, while glucocorticoids can partially mitigate the decline in survival. SLE is a life-threatening autoimmune disease that significantly increases all-cause mortality. Immunologic derangement and multi-organ damage in SLE is highly heterogeneous and can be long-lasting. • Patients with cormobid SLE showed a significant decline in survival within 180 days following the admission to intensive care unit. • Renal dysfunction emerged as the primary mediating factor, but hematological abnormalities and other factors should also be considered. • Glucocorticoid administration partially mitigated the decline in survival due to SLE. • ICU patients with comorbid SLE deserve more attention, especially to their renal function. • The use of glucocorticoids in patients with comorbid SLE during intensive care may be beneficial.
Source: BMC Rheumatology
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,190
OpenAlex ID: W4416866571
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