Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study

Abstract Rationale Acute respiratory failure (ARF) in patients admitted to the intensive care unit (ICU) with known or de novo small-vessel vasculitis (Svv) may be secondary to the underlying immune disease or to other causes. Early identification of the cause of ARF is essential to initiate the mos...

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Autores principales:	Aude Gibelin, Guillaume Dumas, Sandrine Valade, Marc Pineton de Chambrun, François Bagate, Mathilde Neuville, Francis Schneider, Loredana Baboi, Matthieu Groh, Jean-Herlé Raphalen, Jean-Daniel Chiche, Nicolas De Prost, Charles-Edouard Luyt, Claude Guérin, Eric Maury, Etienne de Montmollin, Alexandre Hertig, Antoine Parrot, Raphaël Clere-Jehl, Muriel Fartoukh
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Vasculitis Diffuse alveolar hemorrhage Intensive care Acute respiratory failure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/c9cb802d74e44f7eb8fb2bf51b0d0461
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spelling	oai:doaj.org-article:c9cb802d74e44f7eb8fb2bf51b0d04612021-11-28T12:03:41ZCauses of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study10.1186/s13613-021-00946-x2110-5820https://doaj.org/article/c9cb802d74e44f7eb8fb2bf51b0d04612021-11-01T00:00:00Zhttps://doi.org/10.1186/s13613-021-00946-xhttps://doaj.org/toc/2110-5820Abstract Rationale Acute respiratory failure (ARF) in patients admitted to the intensive care unit (ICU) with known or de novo small-vessel vasculitis (Svv) may be secondary to the underlying immune disease or to other causes. Early identification of the cause of ARF is essential to initiate the most appropriate treatment in a timely fashion. Methods A retrospective multicenter study in 10 French ICUs from January 2007 to January 2018 to assess the clinical presentation, main causes and outcome of ARF associated with Svv, and to identify variables associated with non-immune etiology of ARF in patients with known Svv. Results During the study period, 121 patients [62 (50–75) years; 62% male; median SAPSII and SOFA scores 39 (27–52) and 6 (4–8), respectively] were analyzed. An immune cause was identified in 67 (55%), and a non-immune cause in 54 (45%) patients. ARF was associated with several causes in 43% (n = 52) of cases. The main immune cause was diffuse alveolar hemorrhage (DAH) (n = 47, 39%), whereas the main non-immune cause was pulmonary infection (n = 35, 29%). The crude 90-day and 1-year mortality were higher in patients with non-immune ARF, as compared with their counterparts (32% and 38% vs. 15% and 20%, respectively; both p = 0.03), but was marginally significantly higher after adjusted analysis in a Cox model (p = 0.053). Among patients with a known Svv (n = 70), immunosuppression [OR 9.41 (1.52–58.3); p = 0.016], and a low vasculitis activity score [0.84 (0.77–0.93)] were independently associated with a non-immune cause, after adjustment for the time from disease onset to ARF, time from respiratory symptoms to ICU admission, and severe renal failure. Conclusions An extensive diagnosis workup is mandatory in ARF revealing or complicating Svv. Non-immune causes are involved in 43% of cases, and their short and mid-term prognosis may be poorer than those of immune ARF. Readily identified predictive factors of a non-immune cause could help avoiding unnecessary immunosuppressive therapies.Aude GibelinGuillaume DumasSandrine ValadeMarc Pineton de ChambrunFrançois BagateMathilde NeuvilleFrancis SchneiderLoredana BaboiMatthieu GrohJean-Herlé RaphalenJean-Daniel ChicheNicolas De ProstCharles-Edouard LuytClaude GuérinEric MauryEtienne de MontmollinAlexandre HertigAntoine ParrotRaphaël Clere-JehlMuriel FartoukhSpringerOpenarticleVasculitisDiffuse alveolar hemorrhageIntensive careAcute respiratory failureMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAnnals of Intensive Care, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Vasculitis Diffuse alveolar hemorrhage Intensive care Acute respiratory failure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Vasculitis Diffuse alveolar hemorrhage Intensive care Acute respiratory failure Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Aude Gibelin Guillaume Dumas Sandrine Valade Marc Pineton de Chambrun François Bagate Mathilde Neuville Francis Schneider Loredana Baboi Matthieu Groh Jean-Herlé Raphalen Jean-Daniel Chiche Nicolas De Prost Charles-Edouard Luyt Claude Guérin Eric Maury Etienne de Montmollin Alexandre Hertig Antoine Parrot Raphaël Clere-Jehl Muriel Fartoukh Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
description	Abstract Rationale Acute respiratory failure (ARF) in patients admitted to the intensive care unit (ICU) with known or de novo small-vessel vasculitis (Svv) may be secondary to the underlying immune disease or to other causes. Early identification of the cause of ARF is essential to initiate the most appropriate treatment in a timely fashion. Methods A retrospective multicenter study in 10 French ICUs from January 2007 to January 2018 to assess the clinical presentation, main causes and outcome of ARF associated with Svv, and to identify variables associated with non-immune etiology of ARF in patients with known Svv. Results During the study period, 121 patients [62 (50–75) years; 62% male; median SAPSII and SOFA scores 39 (27–52) and 6 (4–8), respectively] were analyzed. An immune cause was identified in 67 (55%), and a non-immune cause in 54 (45%) patients. ARF was associated with several causes in 43% (n = 52) of cases. The main immune cause was diffuse alveolar hemorrhage (DAH) (n = 47, 39%), whereas the main non-immune cause was pulmonary infection (n = 35, 29%). The crude 90-day and 1-year mortality were higher in patients with non-immune ARF, as compared with their counterparts (32% and 38% vs. 15% and 20%, respectively; both p = 0.03), but was marginally significantly higher after adjusted analysis in a Cox model (p = 0.053). Among patients with a known Svv (n = 70), immunosuppression [OR 9.41 (1.52–58.3); p = 0.016], and a low vasculitis activity score [0.84 (0.77–0.93)] were independently associated with a non-immune cause, after adjustment for the time from disease onset to ARF, time from respiratory symptoms to ICU admission, and severe renal failure. Conclusions An extensive diagnosis workup is mandatory in ARF revealing or complicating Svv. Non-immune causes are involved in 43% of cases, and their short and mid-term prognosis may be poorer than those of immune ARF. Readily identified predictive factors of a non-immune cause could help avoiding unnecessary immunosuppressive therapies.
format	article
author	Aude Gibelin Guillaume Dumas Sandrine Valade Marc Pineton de Chambrun François Bagate Mathilde Neuville Francis Schneider Loredana Baboi Matthieu Groh Jean-Herlé Raphalen Jean-Daniel Chiche Nicolas De Prost Charles-Edouard Luyt Claude Guérin Eric Maury Etienne de Montmollin Alexandre Hertig Antoine Parrot Raphaël Clere-Jehl Muriel Fartoukh
author_facet	Aude Gibelin Guillaume Dumas Sandrine Valade Marc Pineton de Chambrun François Bagate Mathilde Neuville Francis Schneider Loredana Baboi Matthieu Groh Jean-Herlé Raphalen Jean-Daniel Chiche Nicolas De Prost Charles-Edouard Luyt Claude Guérin Eric Maury Etienne de Montmollin Alexandre Hertig Antoine Parrot Raphaël Clere-Jehl Muriel Fartoukh
author_sort	Aude Gibelin
title	Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
title_short	Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
title_full	Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
title_fullStr	Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
title_full_unstemmed	Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
title_sort	causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/c9cb802d74e44f7eb8fb2bf51b0d0461
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Causes of acute respiratory failure in patients with small-vessel vasculitis admitted to intensive care units: a multicenter retrospective study

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