Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit.
OBJECTIVE
Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU.


METHODS
We performed a single-center retrospective study over 6 years (November 2006-December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed.


RESULTS
Forty-one patients with a median age of 50 years [interquartile range (IQR) 40-65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34-128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%.


CONCLUSION
This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.
['Pène|Frédéric|F|', 'Hissem|Tarik|T|', 'Bérezné|Alice|A|', 'Allanore|Yannick|Y|', 'Geri|Guillaume|G|', 'Charpentier|Julien|J|', 'Avouac|Jérôme|J|', 'Guillevin|Loïc|L|', 'Cariou|Alain|A|', 'Chiche|Jean-Daniel|JD|', 'Mira|Jean-Paul|JP|', 'Mouthon|Luc|L|']
D000328:Adult D000368:Aged D005260:Female D006801:Humans D007362:Intensive Care Units D008297:Male D008875:Middle Aged D011379:Prognosis D012121:Respiration, Artificial D012189:Retrospective Studies D012595:Scleroderma, Systemic
OUTCOME SYSTEMIC SCLEROSIS INTENSIVE CARE UNIT MECHANICAL VENTILATION