Analysis of Causes, Prognosis and Factors Associated with Mortality in Patients with Systemic Lupus Erythematosus for Emergency Call in a Medical Center of Northern Taiwan

紅斑性狼瘡病人至急診就診之原因與預後之分析－北臺灣某醫學中心之經驗

潘郁仁(Yu-Jen Pan) ； 謝松洲(Song-Chou Hsieh) ； 許秉寧(Ping-Ning Hsu) ； 余家利(Chia-Li Yu)

《Formosan Journal of Rheumatology》 21卷1期 (2007/06) Pp. 4-12

https://doi.org/10.6313/FJR.2007.21(01).02

摘要

Objective: To identify causes of visiting Emergency Department (ED), factors associated with need for hospitalization, and risk factors of mortality in systemic lupus erythematosus (SLE) patients.
Methods: Medical records were reviewed in 209 SLE patients who ever visited our ED from June 2002 to May 2005. Group A consisted of 130 patients who deceased at ED, or required hospitalization or second visit to ED. Patients not fulfilling the criteria of group A were included in group B.
Results: Fever was noted in 47.8% of patients. Aside from fever, the main cause of visiting ED was gastrointestinal tract symptoms in 54 (25.8%) patients. Patients in group A had higher SLICC score (2.19 ± 2.65 vs. 1.29± 1.72) and SLEDAI-2K at ED (9.65 ± 6.08 vs. 5.83 ± 5.71). We also observed more frequent positive anti-RNP, fever, C-reactive protein (CRP), and increase in steroid dosage or hospitalization within 1 month before visiting ED in group A, but hemoglobin level and platelet count were lower. Among deceased patients, higher SLICC score, more antiphospholipid syndrome (15.8% vs. 3.6%), decreased oxygen saturation (defined as SpO2 ＜ 95%) (31.6% vs. 7.2%), worse anemia and lymphopenia, and higher level of serum creatinine and CRP were observed. The most common cause of mortality in group A was septic shock in 12 of 19 patients and 8 of them died of nosocomial infections.
Conclusions: Various factors were associated with the requirement of hospitalization and short-term mortality in SLE patients visited ED. Among these patients, the major cause of death was subsequent nosocomial infections.

關鍵字

急診醫學 ； 敗血性休克 ； 紅斑性狼瘡

並列摘要

Objective: To identify causes of visiting Emergency Department (ED), factors associated with need for hospitalization, and risk factors of mortality in systemic lupus erythematosus (SLE) patients.
Methods: Medical records were reviewed in 209 SLE patients who ever visited our ED from June 2002 to May 2005. Group A consisted of 130 patients who deceased at ED, or required hospitalization or second visit to ED. Patients not fulfilling the criteria of group A were included in group B.
Results: Fever was noted in 47.8% of patients. Aside from fever, the main cause of visiting ED was gastrointestinal tract symptoms in 54 (25.8%) patients. Patients in group A had higher SLICC score (2.19 ± 2.65 vs. 1.29± 1.72) and SLEDAI-2K at ED (9.65 ± 6.08 vs. 5.83 ± 5.71). We also observed more frequent positive anti-RNP, fever, C-reactive protein (CRP), and increase in steroid dosage or hospitalization within 1 month before visiting ED in group A, but hemoglobin level and platelet count were lower. Among deceased patients, higher SLICC score, more antiphospholipid syndrome (15.8% vs. 3.6%), decreased oxygen saturation (defined as SpO2 ＜ 95%) (31.6% vs. 7.2%), worse anemia and lymphopenia, and higher level of serum creatinine and CRP were observed. The most common cause of mortality in group A was septic shock in 12 of 19 patients and 8 of them died of nosocomial infections.
Conclusions: Various factors were associated with the requirement of hospitalization and short-term mortality in SLE patients visited ED. Among these patients, the major cause of death was subsequent nosocomial infections.

並列關鍵字

Emergency medicine ； septic shock ； systemic lupus erythematosus