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

Julien Demiselle (1, 2) , Johann Auchabie (1) , Francois Beloncle (1) , Philippe Gatault (3) , Steven Grangé (4) , Damien Du Cheyron (5) , Jean Dellamonica (6) , Sonia Boyer (6) , Dimitri Titeca Beauport (7) , Lise Piquilloud (8, 1) , Julien Letheulle (9) , Christophe Guitton (10, 11) , Nicolas Chudeau (12) , Guillaume Geri (13) , François Fourrier (14) , René Robert (15) , Emmanuel Guérot (16) , Julie Boisramé-Helms (17, 18) , Pierre Galichon (19, 20) , Pierre-François Dequin (21) , Alexandre Lautrette (22) , Pierre-Edouard Bollaert (23) , Ferhat Meziani (17, 18) , Loïc Guillevin (24) , Nicolas Lerolle (1) , Jean-François Augusto (2)

1 Service de Réanimation Médicale, CHU d'Angers, France
2 Dpt Néphrologie Dialyse Transplantation [CHU Angers]
3 Service de Néphrologie CHU TOURS
4 Service de Réanimation Médicale [CHU Rouen]
5 Service de réanimation médicale [CHU Caen]
6 CHU - Hôpital Archet 2 [Nice]
7 CHU Amiens-Picardie
8 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
10 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
11 CHU Nantes - Centre Hospitalier Universitaire de Nantes
12 Centre Hospitalier Le Mans (CH Le Mans)
13 Service de réanimation médicale polyvalente [CHU Cochin]
14 Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille
15 Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France
16 HEGP - Hôpital Européen Georges Pompidou [APHP]
17 Service de Réanimation Médicale [Strasbourg]
18 FMTS - Fédération de Médecine Translationnelle de Strasbourg
19 UPMC - Université Pierre et Marie Curie - Paris 6
20 CHU Tenon [AP-HP]
21 Hôpital Bretonneau
22 CHU Gabriel Montpied [Clermont-Ferrand]
23 Service de Réanimation Médicale [CHRU Nancy]
24 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]

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

Mots clés: Anti-neutrophil cytoplasmic antibody; ANCA-associated vasculitis; Intensive care unit; Mortality

Domaines: Médecine humaine et pathologie

Julien Demiselle, Johann Auchabie, Francois Beloncle, Philippe Gatault, Steven Grangé, et al.. Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study. Annals of Intensive Care, 2017, 7, pp.39. ⟨10.1186/s13613-017-0262-9⟩. ⟨hal-01522822⟩