In-Hospital Mortality-Associated Factors of Thrombotic Antiphospholipid Syndrome Patients Requiring Intensive Care Unit Admission - Université Sorbonne Paris Nord Accéder directement au contenu
Article Dans Une Revue Chest Année : 2019

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

Aude Gibelin
  • Fonction : Auteur
Elie Azoulay
François-Michel Beloncle
  • Fonction : Auteur
Nicolas de Prost
Steven Grange
  • Fonction : Auteur
  • PersonId : 943203
Stanislas Ledochowski
  • Fonction : Auteur

Résumé

Background: 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.
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hal-02387757 , version 1 (18-06-2020)

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Marc Pineton de Chambrun, R. Larcher, Frédéric Pène, Laurent Argaud, Julien Mayaux, et al.. In-Hospital Mortality-Associated Factors of Thrombotic Antiphospholipid Syndrome Patients Requiring Intensive Care Unit Admission. Chest, 2019, 157 (5), pp.1158-1166. ⟨10.1016/j.chest.2019.11.010⟩. ⟨hal-02387757⟩
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