Predictors of lethal outcome in patients with immunoinflammatory diseases hospitalized in the intensive care unit

Table 1 Demographic characteristics, treatments, and outcomes of patients with immunoinflammatory diseases hospitalized in the intensive care unit

Parameter	n = 51
Demographics
Sex, males	23 (45.1)
Age, months, median (25%; 75%)	121 (60; 182)
Disease groups
MIS-C	18 (35.3)
Systemic rheumatic diseases	24 (47.1)
Infections	9 (17.6)
Time to ICU admission from the diagnosis of the disease, days, median (25%; 75%)	10.0 (6.0; 30.0)
Treatment
Preceding IST	14 (27.5)
IST started in ICU	29 (56.9)
Follow-up IST in ICU	43 (84.3)
Outcomes
Duration of stay in ICU, days, median (25%; 75%)	6.0 (4.0; 17.0)
Total hospital staying, days, median (25%; 75%)	24.0 (16.0; 44.0)
Lethal outcome	13 (25.5)
Days before death, median (25%; 75%)	39 (17; 62)

Data presented as n (%). ICU: Intensive care unit; IST: Immune-suppressive treatment; MIS-C: Multisystem inflammatory syndrome associated with coronavirus disease 2019 in children.

Table 2 The features, treatment, and outcomes of the patients with different immune-mediated diseases admitted to the intensive care unit

Parameter	MIS-C (n = 18)	SRD (n = 24)	Infections (n = 9)	P value
Demography
Sex, males	11 (61.1)	8 (33.3)	4 (44.4)	0.201
Age, months, median (25%; 75%)	106 (64; 137)	175 (115; 193)	41 (19; 60)	0.001
Time from the hospital to ICU admission, days, median (25%; 75%)	6 (4; 10)	30 (3; 28)	7 (7; 8)	0.00001
Preceding IST	2 (11.1)	10 (41.1)	2 (22.2)	0.083
Treatment
New IST	16 (88.9)	9 (37.5)	4 (44.4)	0.003
Follow-up IST	18 (100.0)	19 (79.2)	6 (66.7)	0.051
Intravenous immunoglobulin	5 (27.8)	11 (45.8)	4 (44.4)	0.465
Biological treatment	3 (16.7)	3 (12.5)	2 (22.2)	0.784
Outcomes
Total hospital staying, days, median (25%; 75%)	17 (14; 26)	28 (19; 68)	32 (25; 50)	0.013
Duration of stay in ICU, days, median (25%; 75%)	6 (4; 10)	7 (4; 23)	9 (5; 24)	0.534
Invasive mycosis	0 (0)	6 (25)	0 (0)	0.022
Fatal outcome	1 (7.7)	10 (41.7)	2 (15.4)	0.028
Time since ICU admission to dearth, days, median (25%; 75%)	46 (46; 46)	25 (9; 62)	57 (39; 75)	0.544

Data presented as n (%). MIS-C: Multisystem inflammatory syndrome associated with COVID-19 in children; SRD: Systemic rheumatic diseases; ICU: Intensive care unit; IST: Immune-suppressive treatment.

Table 3 Comparison of patients with immune-mediated diseases with lethal outcomes and survivors

Parameter	Dead (n = 13)	Alive (n = 38)	P value
Sex, males	5 (38.5)	18 (47.4)	0.578
Age, months, median (25%; 75%)	175 (165; 192)	102 (57; 162)	0.031
Nosological groups	-	-	0.028
MIS-C	1 (7.7)	17 (44.7)	0.016
Systemic rheumatic diseases	10 (76.9)	14 (36.8)	0.013
Infections	2 (15.4)	7 (18.4)	0.059
Time to ICU from the hospital admission, days, median (25%; 75%)	30 (13; 100)	7 (6; 18)	0.013
Preceding intensive IST	7 (53.9)	7 (18.4)	0.013
Newly started IST in ICU	5 (38.5)	24 (63.2)	0.121
Follow-up IST	12 (92.3)	31 (81.6)	0.359
Overall glucocorticosteroids	12 (92.3)	33 (81.6)	0.359
IVIG	6 (46.2)	13 (35.1)	0.481
Outcomes
Invasive mycosis	5 (38.5)	1 (2.6)	0.0005
Total hospital staying, median (25%; 75%)	46 (21; 90)	24 (16; 30)	0.052
Duration of stay in ICU, days, median (25%; 75%)	30 (9; 46)	6 (4; 10)	0.003

Data presented as n (%). MIS-C: Multisystem inflammatory syndrome associated with coronavirus disease 2019 in children; ICU: Intensive care unit; IST: Immune-suppressive treatment; IVIG: Intravenous immunoglobulin.

Table 4 Predictors of fatal outcomes in patients with immune-inflammatory diseases hospitalized to intensive care unit

Predictors	Se	Sp	OR (95%CI)	RR (95%CI)	P value
Age > 162 months	76.9	76.3	10.7 (2.4-47.2)	5.6 (1.8-17.9)	0.0006
The time between onset of disease and ICU admission > 26 days	66.7	85.7	12.0 (2.6-55.3)	5.2 (1.9-14.5)	0.0005
Preceding IST	53.8	83.8	6.2 (1.6-24.0)	3.3 (1.4-8.1)	0.013
Invasive mycosis	38.5	97.4	18.8 (1.9-184.1)	4.7 (2.3-9.7)	0.0005
Hospital stay > 37 days	61.5	84.2	8.5 (2.1-35.2)	4.2 (1.7-10.8)	0.001
Stay in ICU for > 15 days	69.2	89.5	19.1 (4.0-91.8)	6.6 (2.4-17.8)	0.00003
Systemic rheumatic diseases: Yes	76.9	68.4	7.2 (1.7-31.1)	4.4 (1.4-14.1)	0.004

Se: Sensitivity; Sp: Specificity; CI: Confidence interval; OR: Odds ratio; RR: Relative ratio; ICU: Intensive care unit; IST: Immune-suppressive treatment.

Table 5 The final predictors of the fatal outcome (multiple regression analysis data)

Predictor	β	SE	P value
Intercept	0.013	0.066	0.847
ICU stay > 15 days	0.525	0.011	0.00002
Systemic rheumatic diseases (vs other diseases)	0.251	0.01	0.015

ICU: Intensive care unit.