In-Hospital Mortality-Associated Factors in Patients With Thrombotic Antiphospholipid Syndrome Requiring ICU Admission

被引：13

作者：

de Chambrun, Marc Pineton ^{[1
,2
]}

Larcher, Romaric ^{[3
,4
]}

Pene, Frederic ^{[5
,6
]}

Argaud, Laurent ^{[7
]}

Mayaux, Julien ^{[8
]}

Jamme, Matthieu ^{[9
]}

Coudroy, Remi ^{[10
]}

Mathian, Alexis ^{[1
]}

Gibelin, Aude ^{[11
]}

Azoulay, Elie ^{[12
]}

Tandjaoui-Lambiotte, Yacine ^{[13
]}

Dargent, Auguste ^{[14
]}

Beloncle, Francois-Michel ^{[15
]}

Raphalen, Jean-Herle ^{[16
]}

Couteau-Chardon, Amelie ^{[17
]}

de Prost, Nicolas ^{[18
]}

Devaquet, Jerome ^{[19
]}

Contou, Damien ^{[20
]}

Gaugain, Samuel ^{[21
]}

Trouiller, Pierre ^{[22
,23
]}

Grange, Steven ^{[24
]}

Ledochowski, Stanislas ^{[25
]}

Lemarie, Jeremie ^{[26
]}

Faguer, Stanislas ^{[27
]}

Degos, Vincent ^{[28
]}

Luyt, Charles-Edouard ^{[2
]}

Combes, Alain ^{[2
]}

Amoura, Zahir ^{[1
]}

机构：

[1] Sorbonne Univ, Hop La Pitie Salpetriere, AP HP,Inst E3M,Syndrome Anticorps Antiphospholipi, Serv Med Interne 2,Ctr Reference Natl Lupus Syste, Paris, France

[2] Sorbonne Univ, Hop La Pitie Salpetriere, AP HP, Inst Cardiometab & Nutr ICAN,Serv Med Intens Rean, Paris, France

[3] Ctr Hosp Univ CHU Montpellier, Hop Lapeyronie, Serv Med Intens Reanimat, Montpellier, France

[4] Univ Montpellier, INSERM, CNRS, PhyMedExp, Montpellier, France

[5] Hop Cochin, AP HP, Hop Univ Paris Ctr, Serv Med Intens Reanimat, Paris, France

[6] Univ Pariscartes, AP HP, Paris, France

[7] Hosp Civils Lyon, Serv Med Intens Reanimat, Hop Edouard Herriot, Lyon, France

[8] Sorbonne Univ, Hop La Pitie Salpetriere, AP HP,Neurophysiol Resp Expt & Clin, INSERM,UMRS1158,Dept R3S,Serv Pneumol Med Intensi, Paris, France

[9] Sorbonne Univ, Hop Tenon, AP HP, Serv Urgences Nephrol & Transplantat Renale, Paris, France

[10] Univ Poitiers, Serv Med Intens Reanimat, CHU Poitiers, Grp ALIVE,INSERM CIC1402, Poitiers, France

[11] Sorbonne Univ, Hop Tenon, AP HP, Serv Reanimat Medicochirurgicale,Pole Thorax Voie, Paris, France

[12] Hop St Louis, AP HP, Serv Med Intens Reanimat, Paris, France

[13] Hop Avicenne, AP HP, HUPSSD, Serv Reanimat Med Chirurgicale, Bobigny, France

[14] CHU Dijon, Serv Med Intens Reanimat, UMR 1231, INSERM,LabEx Lipstic, Dijon, France

[15] Univ Angers, Dept Med Intens Reanimat & Med Hyperbare, CHU Angers, Angers, France

[16] Univ Paris 05, Hop Necker, AP HP, Serv Anesthesie & Reanimat, Paris, France

[17] Univ Paris 05, Hop Europeen George Pompidou, AP HP, Serv Med Intens Reanimat, Paris, France

[18] CHU Henri Mondor, AP HP, Serv Med Intens Reanimat, Creteil, France

[19] Hop Foch, Serv Reanimat Polyvalente, Suresnes, France

[20] Ctr Hosp Victor Dupouy, Serv Reanimat Polyvalente, Argenteuil, France

[21] Univ Paris Diderot, Hop St Louis Lariboisiere, AP HP, Dept Anesthesie & Reanimat, Paris, France

[22] Hop Antoine Beclere, AP HP, Hop Univ Paris Sud, Serv Reanimat Polyvalente, Clamart, France

[23] Hop Antoine Beclere, AP HP, Hop Univ Paris Sud, Unite Surveillance Continue, Clamart, France

[24] Hop Charles Nicolle, CHU Rouen, Serv Med Intens Reanimat, Rouen, France

[25] CH Pierre Oudot, Serv Reanimat Polyvalente, Bourgoin Jallieu, France

[26] CHRU Nancy, Serv Reanimat Med, Hop Cent, Nancy, France

[27] CHU Toulouse, Dept Nephrol & Transplantat Organes, Unite Reanimat, Ctr Reference Malad Renales Rares, Toulouse, France

[28] Sorbonne Univ, Hop La Pitie Salpetriere, AP HP, Serv Reanimat Neurochirurgicale, Paris, France

来源：

CHEST | 2020年 / 157卷 / 05期

关键词：

antiphospholipid syndrome; catastrophic antiphospholipid syndrome; ICU; systemic lupus erythematosus; INTERNATIONAL CONSENSUS STATEMENT; CLASSIFICATION CRITERIA; DESCRIPTIVE ANALYSIS; VALIDATION; RITUXIMAB;

D O I：

10.1016/j.chest.2019.11.010

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: The antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by thrombotic events that can require ICU admission because of organ dysfunction related to macrovascular and/or microvascular thrombosis. Critically ill patients with thrombosis and APS were studied to gain insight into their prognoses and in-hospital mortality-associated factors. METHODS: This French national, multicenter, retrospective study included all patients with APS and any new thrombotic manifestations admitted to 24 ICUs (January 2000-September 2018). RESULTS: During the study period, 134 patients (male/female ratio, 0.4) with 152 APS episodes were admitted to the ICU (mean age at admission, 46.0 +/- 15.1 years). In-hospital mortality of their 134 last episodes was 35 of 134 (26.1%). The Cox multivariable model retained certain factors (hazard ratio [95% CI]: age >= 40 years, 11.4 [3.1-41.5], P < .0001; mechanical ventilation, 11.0 [3.3-37], P < .0001; renal replacement therapy, 2.9 [1.3-6.3], P = .007; and in-ICU anticoagulation, 0.1 [0.03-0.3], P < .0001) as independently associated with in-hospital mortality. For the subgroup of definite/probable catastrophic APS, the Cox bivariable model (including the Simplified Acute Physiology Score II score) retained double therapy (corticosteroids + anticoagulant, 0.2 [0.07-0.6]; P = .005) but not triple therapy (corticosteroids + anticoagulant + IV immunoglobulins or plasmapheresis: hazard ratio, 0.3 [0.1-1.1]; P = .07) as independently associated with in-hospital mortality. CONCLUSIONS: In-ICU anticoagulation was the only APS-specific treatment independently associated with survival for all patients. Double therapy was independently associated with better survival of patients with definite/probable catastrophic APS. In these patients, further studies are needed to determine the role of triple therapy.

引用

页码：1158 / 1166

页数：9

共 19 条

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