Autoimmunity reviews · 2025
Systemic lupus erythematosus in critical care: A systematic review of ICU outcomes and management.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Ramírez-Lara Edith, Mendoza-Pinto Claudia, Munguía-Realpozo Pamela, Saavedra-Salinas Miguel Ángel, Etchegaray-Morales Ivet, Ayón-Aguilar Jorge, Montiel-Jarquín Álvaro José, Martínez-Méndez Socorro
Аннотация
BACKGROUND: Systemic lupus erythematosus (SLE) often progresses to critical illness requiring intensive care unit (ICU) admission, yet contemporary data on outcomes, prognostic factors, and therapeutic approaches are scattered.
OBJECTIVE: To synthesize recent evidence on causes of ICU admission, mortality predictors, and management strategies in adult SLE.
METHODS: A PRISMA-compliant search of PubMed, Web of Science and Cochrane Library (inception-31 December 2024) retrieved studies enrolling adults (≥18 years) with confirmed SLE treated in ICUs. Two reviewers independently selected articles and extracted data; methodological heterogeneity precluded meta-analysis, so results were narratively synthesized.
RESULTS: Thirty-nine studies met the criteria. Infection (40 %), pulmonary involvement (17 %) and renal flares (13 %) were the most common admission triggers. Reported ICU mortality ranged from 20 % to 82 % but rose sharply when baseline Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) exceeded 16, approximating 80 % mortality (sensitivity 84 %, specificity 90 %) and outperforming Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) in discriminating survivors. Additional independent predictors were APACHE II > 16, need for mechanical ventilation, renal replacement therapy and vasopressor support. Mechanical ventilation (59 %) and vasoactive agents (39 %) were the predominant ICU interventions. Immunomodulatory management was heterogeneous: high-dose corticosteroids and cyclophosphamide were ubiquitous, whereas mycophenolate, antimalarials, intravenous immunoglobulin, plasmapheresis, and extracorporeal membrane oxygenation were reserved for selected scenarios.
CONCLUSIONS: Early recognition of poor prognostic factors and prompt ICU admission are essential to improving outcomes in SLE.
OBJECTIVE: To synthesize recent evidence on causes of ICU admission, mortality predictors, and management strategies in adult SLE.
METHODS: A PRISMA-compliant search of PubMed, Web of Science and Cochrane Library (inception-31 December 2024) retrieved studies enrolling adults (≥18 years) with confirmed SLE treated in ICUs. Two reviewers independently selected articles and extracted data; methodological heterogeneity precluded meta-analysis, so results were narratively synthesized.
RESULTS: Thirty-nine studies met the criteria. Infection (40 %), pulmonary involvement (17 %) and renal flares (13 %) were the most common admission triggers. Reported ICU mortality ranged from 20 % to 82 % but rose sharply when baseline Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) exceeded 16, approximating 80 % mortality (sensitivity 84 %, specificity 90 %) and outperforming Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) in discriminating survivors. Additional independent predictors were APACHE II > 16, need for mechanical ventilation, renal replacement therapy and vasopressor support. Mechanical ventilation (59 %) and vasoactive agents (39 %) were the predominant ICU interventions. Immunomodulatory management was heterogeneous: high-dose corticosteroids and cyclophosphamide were ubiquitous, whereas mycophenolate, antimalarials, intravenous immunoglobulin, plasmapheresis, and extracorporeal membrane oxygenation were reserved for selected scenarios.
CONCLUSIONS: Early recognition of poor prognostic factors and prompt ICU admission are essential to improving outcomes in SLE.