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In-Hospital Mortality-Associated Factors of Thrombotic Antiphospholipid Syndrome Patients Requiring Intensive Care Unit Admission

By Marc Pineton De Chambrun, R. Larcher, Frédéric Pène, Laurent Argaud, Julien Mayaux, Matthieu Jamme, Rémi Coudroy, Alexis Mathian, Aude Gibelin, Elie Azoulay, Yacine Tandjaoui-Lambiotte, Auguste Dargent, François-Michel Beloncle, Jean-Herlé Raphalen, Amélie Couteau-Chardon, Nicolas De Prost, Jérôme Devaquet, Damien Contou, Samuel Gaugain, Pierre Trouiller, Steven Grange, Stanislas Ledochowski, Jérémie Lemarié, Stanislas Faguer, Vincent Degos, Charles-Edouard Luyt, Alain Combes and Zahir Amoura

Abstract

International audienceBackground: The antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by thrombotic events that can require ICU admission because of organ dysfunction related to macrovascular and/or microvascular thrombosis. Critically ill patients with thrombosis and APS were studied to gain insight into their prognoses and in-hospital mortality-associated factors.Methods: This French national, multicenter, retrospective study included all patients with APS and any new thrombotic manifestations admitted to 24 ICUs (January 2000-September 2018).Results: During the study period, 134 patients (male/female ratio, 0.4) with 152 APS episodes were admitted to the ICU (mean age at admission, 46.0 ± 15.1 years). In-hospital mortality of their 134 last episodes was 35 of 134 (26.1%). The Cox multivariable model retained certain factors (hazard ratio [95% CI]: age ≥ 40 years, 11.4 [3.1-41.5], P < .0001; mechanical ventilation, 11.0 [3.3-37], P < .0001; renal replacement therapy, 2.9 [1.3-6.3], P = .007; and in-ICU anticoagulation, 0.1 [0.03-0.3], P < .0001) as independently associated with in-hospital mortality. For the subgroup of definite/probable catastrophic APS, the Cox bivariable model (including the Simplified Acute Physiology Score II score) retained double therapy (corticosteroids + anticoagulant, 0.2 [0.07-0.6]; P = .005) but not triple therapy (corticosteroids + anticoagulant + IV immunoglobulins or plasmapheresis: hazard ratio, 0.3 [0.1-1.1]; P = .07) as independently associated with in-hospital mortality.Conclusions: In-ICU anticoagulation was the only APS-specific treatment independently associated with survival for all patients. Double therapy was independently associated with better survival of patients with definite/probable catastrophic APS. In these patients, further studies are needed to determine the role of triple therapy

Topics: systemic lupus erythematosus, catastrophic antiphospholipid syndrome, intensive care unit, antiphospholipid syndrome, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Publisher: 'Elsevier BV'
Year: 2019
DOI identifier: 10.1016/j.chest.2019.11.010
OAI identifier: oai:HAL:hal-02387757v1
Provided by: HAL-HCL
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