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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1755444
Original Article

Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America

Valeria Erazo-Martínez
1   Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
,
Ingrid Ruiz-Ordoñez
1   Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
,
Carolina Álvarez
2   Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
,
Laura Serrano
2   Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
,
Cristian C. Aragón
3   Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
,
Gabriel J. Tobón
3   Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
4   Fundación Valle del Lili, Unidad de Reumatología, Cali, Colombia
,
Sandra Concha
5   Fundación Valle del Lili, Unidad de cuidado crítico pediátrico, Cali, Colombia
,
Rubén Lasso
5   Fundación Valle del Lili, Unidad de cuidado crítico pediátrico, Cali, Colombia
6   Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
,
Lyna- Ramírez
4   Fundación Valle del Lili, Unidad de Reumatología, Cali, Colombia
› Author Affiliations Funding None.
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Abstract

Most autoimmune diseases (AIDs) during childhood debut with more severe and aggressive forms, with life-threatening conditions that increase the need for intensive care therapy. This study describes the clinical, laboratory, and health outcome features of pediatric patients with AIDs admitted to the pediatric intensive care unit (PICU). This is a retrospective cross-sectional study that included the clinical records of all pediatric patients with AIDs admitted to the PICU between 2011 and 2020 in Cali, Colombia. In total, 225 PICU admissions from 136 patients were evaluated. Median age was 13 (11–15) years, and the median disease duration was 15 (5–38.5) months. Systemic lupus erythematosus was the most prevalent disease (91, 66.9%), followed by vasculitis (27, 19.8%). The leading cause of PICU admission was AID activity (95, 44.3%). C-reactive-protein levels were associated with infections (p <0.0394). Mortality occurred in 12 (8.8%) patients secondary to AID activity, primarily, diffuse alveolar hemorrhage (6, 50%). A longer disease duration was associated with mortality (p <0.00398). AID activity was the leading cause of PICU admission and mortality. Pulse steroid therapy, mechanical ventilation, and inotropic and vasopressor support were associated with nonsurvival.

Keywords

Autoimmune diseases - pediatric intensive care unit - childhood-onset systemic lupus erythematosus


Publication History

Received: 17 January 2022

Accepted: 28 June 2022

Article published online:
19 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Surace AEA, Hedrich CM. The role of epigenetics in autoimmune/inflammatory disease. Front Immunol 2019; 10: 1525
    CrossrefPubMedGoogle Scholar
  • 2 Theofilopoulos AN, Kono DH, Baccala R. The multiple pathways to autoimmunity. Nat Immunol 2017; 18 (07) 716-724
    CrossrefPubMedGoogle Scholar
  • 3 Legoux FP, Lim JB, Cauley AW. et al. CD4+ T cell tolerance to tissue-restricted self antigens is mediated by antigen-specific regulatory T cells rather than deletion. Immunity 2015; 43 (05) 896-908
    CrossrefPubMedGoogle Scholar
  • 4 Dalrymple AM, Moore TL. Laboratory evaluation in pediatric autoimmune diseases. Pediatr Rev 2015; 36 (11) 496-501 , quiz 502
    CrossrefPubMedGoogle Scholar
  • 5 Chabert P, Danjou W, Mezidi M. et al. Short- and long-term prognosis of acute critically ill patients with systemic rheumatic diseases: a retrospective multicentre study. Medicine (Baltimore) 2021; 100 (35) e26164
    CrossrefPubMedGoogle Scholar
  • 6 Lee J, Dhillon N, Pope J. All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatology (Oxford) 2013; 52 (05) 905-909
    CrossrefPubMedGoogle Scholar
  • 7 Shulman AI, Punaro M. Critical care of the pediatric patient with rheumatic disease. Curr Opin Pediatr 2011; 23 (03) 263-268
    CrossrefPubMedGoogle Scholar
  • 8 Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40 (09) 1725
    CrossrefPubMedGoogle Scholar
  • 9 Jennette JC, Falk RJ, Bacon PA. et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 10 Petty RE, Southwood TR, Manners P. et al; International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31 (02) 390-392
    PubMedGoogle Scholar
  • 11 Lundberg IE, Bottai M, Tjärnlund A. Response to: 'Performance of the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies in clinical practice' by Hočevar et al . Ann Rheum Dis 2018; 77 (12) e91
    CrossrefPubMedGoogle Scholar
  • 12 Miyakis S, Lockshin MD, Atsumi T. et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4 (02) 295-306
    CrossrefPubMedGoogle Scholar
  • 13 van den Hoogen F, Khanna D, Fransen J. et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72 (11) 1747-1755
    CrossrefPubMedGoogle Scholar
  • 14 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 15 Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29 (02) 288-291
    PubMedGoogle Scholar
  • 16 Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine 2014; 81 (02) 112-117
    CrossrefPubMedGoogle Scholar
  • 17 Gillispie M, Muscal E, Rama J, Falco C, Brown A. Pediatric rheumatology curriculum for the pediatrics resident: a case-based approach to learning. MedEdPORTAL 2018; 14: 10767
    CrossrefPubMedGoogle Scholar
  • 18 García-Rodríguez F, Gamboa-Alonso A, Jiménez-Hernández S. et al. Economic impact of juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J 2021; 19 (01) 152
    CrossrefPubMedGoogle Scholar
  • 19 Fonseca R, Aguiar F, Rodrigues M, Brito I. Clinical phenotype and outcome in lupus according to age: a comparison between juvenile and adult onset. Reumatol Clin (Engl Ed) 2018; 14 (03) 160-163 (Engl Ed)
    CrossrefPubMedGoogle Scholar
  • 20 Silva CA. Childhood-onset systemic lupus erythematosus: early disease manifestations that the paediatrician must know. Expert Rev Clin Immunol 2016; 12 (09) 907-910
    CrossrefPubMedGoogle Scholar
  • 21 Gomes RC, Silva MF, Kozu K. et al. Features of 847 childhood-onset systemic lupus erythematosus patients in three age groups at diagnosis: a Brazilian multicenter study. Arthritis Care Res (Hoboken) 2016; 68 (11) 1736-1741
    CrossrefPubMedGoogle Scholar
  • 22 Horneff G. Biologic-associated infections in pediatric rheumatology. Curr Rheumatol Rep 2015; 17 (11) 66
    CrossrefPubMedGoogle Scholar
  • 23 Castillo RD, De la Pena W, Marzan KA. Diagnosis and management of infectious complications of childhood rheumatic diseases. Curr Rheumatol Rep 2013; 15 (04) 322
    CrossrefPubMedGoogle Scholar
  • 24 Wang J, Niu R, Jiang L. et al. The diagnostic values of C-reactive protein and procalcitonin in identifying systemic lupus erythematosus infection and disease activity. Medicine (Baltimore) 2019; 98 (33) e16798
    CrossrefPubMedGoogle Scholar
  • 25 El-Serougy E, Zayed HS, Ibrahim NM, Maged LA. Procalcitonin and C-reactive protein as markers of infection in systemic lupus erythematosus: the controversy continues. Lupus 2019; 28 (11) 1329-1336
    CrossrefPubMedGoogle Scholar
  • 26 Bernal-Macías S, Reyes-Beltrán B, Molano-González N. et al. Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis. Lupus Sci Med 2015; 2 (01) e000122
    CrossrefPubMedGoogle Scholar
  • 27 Joo YB, Park SY, Won S, Bae SC. Differences in clinical features and mortality between childhood-onset and adult-onset systemic lupus erythematosus: a prospective single-center study. J Rheumatol 2016; 43 (08) 1490-1497
    CrossrefPubMedGoogle Scholar
  • 28 das Chagas Medeiros MM, Bezerra MC, Braga FN. et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE. Lupus 2016; 25 (04) 355-363
    CrossrefPubMedGoogle Scholar
  • 29 Radhakrishna SM, Reiff AO, Marzan KA. et al. Pediatric rheumatic disease in the intensive care unit: lessons learned from 15 years of experience in a tertiary care pediatric hospital. Pediatr Crit Care Med 2012; 13 (03) e181-e186
    CrossrefPubMedGoogle Scholar
  • 30 Al-Mayouf SM, Fallatah R, Al-Twajery M, Alayed T, Alsonbul A. Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit: An experience of a tertiary hospital. Int J Pediatr Adolesc Med 2019; 6 (04) 142-145 [published correction appears in Int J Pediatr Adolesc Med. 2020 Dec;7(4):212]
    CrossrefPubMedGoogle Scholar
  • 31 Tyagi P, Tullu MS, Agrawal M. Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in predicting mortality in a pediatric intensive care unit. J Pediatr Intensive Care 2018; 7 (04) 201-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Abdelkader A, Shaaban M, Zahran M. Using two scores for the prediction of mortality in pediatric intensive care units. Al-Azhar Assiut Med J 2018; 16 (04) 349
    CrossrefPubMedGoogle Scholar
  • 33 Bora R. Prediction of mortality by pediatric risk of mortality (PRISM) III score in NGMC pediatric intensive care unit. J Nepalgunj Med Coll 2019; 17 (01) 5-9
    CrossrefPubMedGoogle Scholar
  • 34 Suárez-Avellaneda A, Quintana JH, Aragón CC. et al. Systemic lupus erythematosus in the intensive care unit: a systematic review. Lupus 2020; 29 (11) 1364-1376
    CrossrefPubMedGoogle Scholar
  • 35 Jiang T, Li QB. [Diffuse alveolar hemorrhage in children]. Zhongguo Dang Dai Er Ke Za Zhi 2019; 21 (09) 949-954
    PubMedGoogle Scholar
  • 36 Blay G, Rodrigues JC, Ferreira JCO. et al; Brazilian Childhood-onset Systemic Lupus Erythematosus Group. Diffuse alveolar hemorrhage in childhood-onset systemic lupus erythematosus: a severe disease flare with serious outcome. Adv Rheumatol 2018; 58 (01) 39
    CrossrefPubMedGoogle Scholar
  • 37 Martínez-Martínez MU, Oostdam DAH, Abud-Mendoza C. Diffuse alveolar hemorrhage in autoimmune diseases. Curr Rheumatol Rep 2017; 19 (05) 27
    CrossrefPubMedGoogle Scholar
  • 38 Gordon D, Chan C, Tran Q. et al. 1271: A meta-analysis of early administration of vasopressor in septic shock: is there mortality benefit?. Crit Care Med 2020; 49 (01) 641-641
    CrossrefPubMedGoogle Scholar
  • 39 Russell JA, Gordon AC, Williams MD, Boyd JH, Walley KR, Kissoon N. Vasopressor therapy in the intensive care unit. Semin Respir Crit Care Med 2021; 42 (01) 59-77
    Article in Thieme ConnectPubMedGoogle Scholar