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Adult respiratory distress syndrome in systemic lupus erythematosus: causes and prognostic factors: a single center, retrospective study

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Author(s)
WU KimSI KimWH YooJH ParkJK MinSC KimYS HongSH LeeSH ParkCS ChoHY Kim
Keimyung Author(s)
Park, Jae Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
Lupus
Issued Date
1999
Volume
8
Issue
7
Keyword
adult respiratory distress syndromecauseprognostic factorslupus
Abstract
Objectives: To determine the causes and prognostic factors of Adult Respiratory Distress
Syndrome (ARDS) in patients with systemic lupus erythematosus (SLE).
Methods: Among 544 Korean SLE patients, who were followed in the Lupus Clinic of the Catholic
Medical Center from 1993 to 1997, patients diagnosed as ARDS were examined retrospectively.
During the study period, non-SLE patients with ARDS were investigated and then compared to SLE
patients with ARDS in terms of clinical variables.
Results: Nineteen patients with SLE were revealed to have a history of ARDS (3.5%) and 13
(68.4%) of 19 patients died. Death related to ARDS was found in 34.2% of all deaths (nˆ38) from
SLE during the study period. The frequency and causes of ARDS were as follows; 9 sepsis or
bacteremia (47.4%), 2 miliary tuberculosis (10.5%), 2 invasive pulmonary aspergillosis (10.5%), 2
acute pulmonary alveolar hemorrhage syndrome (10.5%), 1 acute lupus pneumonitis (5.3%), 1
massive hemorrhage due to placenta previa (5.3%), 1 aspiration pneumonitis (5.3%), 1
disseminated intravascular coagulation associated with systemic vasculitis (5.3%). The main
organisms in sepsis were gram negative bacilli (61.5%) The median steroid dose administered 1
month before ARDS was signi®cantly higher in patients (nˆ13) with infectious ARDS compared
to those (nˆ6) with ARDS due to other causes (Pˆ0.038). Comparison of the laboratory and
clinical variables between the survivors (nˆ6) and the deceased (nˆ13) showed that the survivors
had lower SLAM indices at presentation (Pˆ0.004) and APACHE (Acute Physiology, Age,
Chronic Health Evaluation) III scores within 24 h after diagnosis of ARDS (Pˆ0.024) than the
deceased. The APACHE III scores correlated well with the SLAM indices (rˆ0.615, Pˆ0.007).
Non-SLE patients with ARDS during the study period were selected for comparison to SLE patients
with ARDS. Age at the onset of ARDS was younger in SLE (nˆ19) compared to non-SLE
(nˆ190) (P<0.001). Duration from ARDS onset to death was shorter in SLE patients (P<0.001).
The mortality from ARDS tended to be higher in SLE patients (PˆNS). The ®rst-day APACHE III
score was signi®cantly higher in deceased SLE patients (nˆ13) compared to deceased non-SLE
patients (nˆ105) (Pˆ0.001).
Conclusions: ARDS was a common premortem event of SLE and showed a high fatality rate in
SLE. The most common cause of ARDS in Korean patients with SLE was sepsis by gram negative
bacilli. ARDS in SLE developed at a younger age, and progressed more rapidly compared to ARDS
in general. The SLAM index and APACHE III score could be useful to predict the prognosis of
ARDS in SLE.
Keywords: adult respiratory distress syndrome; cause; prognostic factors; lupus
Keimyung Author(s)(Kor)
박재호
Publisher
School of Medicine
Citation
WU Kim et al. (1999). Adult respiratory distress syndrome in systemic lupus erythematosus: causes and prognostic factors: a single center, retrospective study. Lupus, 8(7), 552–557. doi: 10.1191/096120399678840864
Type
Article
ISSN
0961-2033
Source
http://journals.sagepub.com/doi/abs/10.1191/096120399678840864?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
DOI
10.1191/096120399678840864
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33406
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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