Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study

• DOI: 10.1186/s13613-017-0262-9
• Publication Date: 2017-04-05T13:28:42Z
• Authors: Julien Demiselle; Johann Auchabie; François Beloncle; Philippe Gatault; Steven Grangé; Damien Du Cheyron; Jean Dellamonica; Sonia Boyer; Dimitri Titeca Be...; Lise Piquilloud; Julien Letheulle; Christophe Guitton; Nicolas Chudeau; Guillaume Geri; François Fourrier; René Robert; Emmanuel Guérot; Julie Boisramé-Helms; Pierre Galichon; Pierre-François D...; Alexandre Lautrette; Pierre-Edouard Bo...; Ferhat Meziani; Loïc Guillevin; Nicolas Lerolle; Jean-François Aug...
• Keywords: SAPS II; Nephrology; Granulomatosis with polyangiitis; Renal replacement therapy

Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce. We included 97 consecutive with acute AAV manifestations (new onset or relapsing disease), admitted to 18 units (ICUs) over a 10-year period (2002–2012). A group of 95 new disease, two nephrology departments manifestations, constituted the control group. In ICU group, predominantly showed granulomatosis polyangiitis and proteinase-3 ANCAs. Compared non-ICU comparable Birmingham activity score higher frequency heart, central nervous system lungs involvements. Respiratory assistance, renal replacement therapy vasopressors were required in 68.0, 56.7 26.8% patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% cyclophosphamide, 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) died during stay. The following significantly associated mortality univariate analysis: need respiratory use vasopressors, occurrence at least infection event ICU, cyclophosphamide treatment, sequential organ failure assessment admission simplified physiology II. After adjustment on infection, was no longer risk factor mortality. Despite initial rate within first hospital stay (p < 0.0001), long-term survivors did not differ between groups (18.6 20.4%, respectively, p = 0.36). Moreover, we observed survival difference after 1-year follow-up (82.1 80.5%, 0.94). This study supports idea that experiencing an challenge does impact prognosis patients.