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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcome predictors of systemic lupus erythematosus requiring admission to the intensive care unit
Anitha P Mampilly, Binila Chacko, John Mathew, Krupa George, Anna Paul, Sudha Jasmine, Samuel George, Karthik Gunasekaran, Rajnin Nanda, Vaanya Bansal, John V Peter
Anitha P Mampilly, Rajnin Nanda, Vaanya Bansal, Department of Critical Care, Christian Medical College Vellore, Vellore 632004, Tamil Nadu, India
Binila Chacko, John V Peter, Department of Medical Intensive Care, Christian Medical College Vellore, Vellore 632004, Tamil Nadu, India
John Mathew, Department of Rheumatology, Christian Medical College, Vellore 632004, Tamil Nadu, India
Krupa George, Anna Paul, Department of General Medicine, Christian Medical College Vellore, Vellore 632004, Tamil Nadu, India
Sudha Jasmine, Samuel George, Karthik Gunasekaran, Department of Medicine, Christian Medical College Vellore, Vellore 632004, Tamil Nadu, India
Author contributions: Mampilly AP and Peter JV discussed and designed the study; Mampilly AP wrote the first draft of the manuscript; Chacko B and Peter JV revised the first draft; Mathew J, George K, Paul A, Jasmine S, George S, Gunasekaran K, Nanda R, and Bansal V had an equal role in data collection, analysis; Peter JV helped in further revisions of the manuscript; and supported the writing of the manuscript equally.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Christian Medical College Vellore, approval No. 2407170.
Informed consent statement: As the corresponding author of the above study, I hereby submit that the consent for this study was waived as per institutional policy for a retrospective study with de-identified patient data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Corresponding author(s) agreed with the data sharing policy.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: John V Peter, Department of Medical Intensive Care, Christian Medical College Vellore, Ida Scudder Road, Vellore 632004, Tamil Nadu, India.
peterjohnvictor@yahoo.com.au
Received: April 21, 2025
Revised: May 19, 2025
Accepted: August 13, 2025
Published online: December 9, 2025
Processing time: 221 Days and 9.9 Hours
BACKGROUND
Systemic lupus erythematosus (SLE) patients are admitted to the intensive care unit (ICU) for disease flares and infections, both of which carry a high mortality risk. Studies characterizing the outcome predictors of SLE are few in the Asian continent. This study characterized the clinical profile, treatment, and outcome predictors of ICU admissions with SLE.
AIM
To ascertain the reasons for ICU admission among SLE patients and to explore outcome predictors in these patients. The primary outcome was ICU mortality. Secondary outcomes included need for ventilation, inotropes, renal replacement therapy, and length of ICU and hospital stay.
METHODS
A retrospective study of 77 SLE patients was conducted in the medical ICU of a tertiary care teaching hospital in India. Clinical features, treatment, and outcomes of patients admitted between January 2018 and December 2022 were recorded. Factors associated with mortality were explored using bivariate and multivariate logistic regression analysis and reported as adjusted odds ratios with 95% confidence intervals.
RESULTS
The mean (SD) age was 31.1 (10.3) years; 83.1% were female. The median (interquartile) duration of SLE before admission was 12 (1-60) months; SLE was newly diagnosed in the current admission in 23.4%. The median Acute Physiology and Chronic Health Evaluation II score was 16.3 (14.5-18.2) and similar among survivors and non-survivors; 32 had evidence of disease flare, 44 had an infection, and one patient had an intracranial bleed. ICU admission was for respiratory failure (46.7%), hemodynamic instability (32.5%), and status epilepticus (14.3%). Twenty-nine patients (37.7%) had autoimmune hemolytic anemia, and 11 (14.3%) had diffuse alveolar hemorrhage. Immunomodulation included corticosteroids (96.1%), cyclophosphamide (33.8%), mycophenolate (23.4%), plasma exchange (13%), and immunoglobulins (11.7%). All patients received broad-spectrum antibiotics. Respiratory support, inotropes, and renal replacement therapy were required in 93.5%, 51.7%, and 32.5%, respectively. ICU mortality was 50.7% (95% confidence interval: 39%-62%). The mean ± SD hospital length of stay was 18.9 ± 14.3 days. On multivariate analysis, only shock (P = 0.004) was independently associated with mortality.
CONCLUSION
Intercurrent infection and disease flare are common reasons for ICU admission in SLE patients. Despite multimodal therapy, mortality is high. Shock was independently associated with mortality.
Core Tip: In this retrospective single-center study conducted in a medical intensive care unit (ICU) at a tertiary care teaching hospital in India, patients with systemic lupus erythematosus (SLE) and admitted to the ICU were noted to have a high mortality rate despite initiating multi-modal therapy. Respiratory failure and shock were the major reasons for ICU admissions in SLE. The differentiation between SLE flare and infection can be challenging and is the key to effective treatment.
