Death in patients with immune-mediated inflammatory diseases in the intensive care unit: First week data

Table 1 General characteristics of patients hospitalized in the intensive care unit and their main outcomes, n (%)/median (interquartile range)

General characteristics of patients	n = 51
Patients’ demography
Gender, male	23 (45.1)
Age, months	121 (60, 182)
Disease groups
MIS-C	18 (35.3)
Systemic rheumatic diseases	24 (47.1)
Infections	9 (17.6)
Preceding immunosuppression	18 (35.3)
Assessment of MAS
Hscore, points	97 (72, 140)
Correspondence to criteria
HLH 2004	4/48 (8.3)
MAS 2005	35/48 (72.9)
EULAR/ACR/PRINTO	19/48 (39.6)
ICU admission and outcomes
Time to ICU admission from the onset of disease, days	10.0 (6.0, 30.0)
Duration of stay in ICU, days	6.0 (4.0, 15.0)
Lethal outcome	13 (25.5)
Days before deaths	39 (17, 62)

MIS-C: Multisystem inflammatory syndrome associated with coronavirus disease 2019 in children; MAS: Macrophage activation syndrome; HLH: Hemophagocytic lymphohistiocytosis; EULAR: European League Against Rheumatism; ACR: American College of Rheumatology; PRINTO: Paediatric Rheumatology International Trials Organisation; ICU: Intensive care unit.

Table 2 Predictors of lethal outcome (data on the first day of stay in the intensive care unit), median (interquartile range)

Predictor	Se	Sp	OR (95%CI)	RR (95%CI)	P value
Diuresis ≤ 1.5 mL/kg/hour	91.7	61.8	17.8 (2.1-154.2)	2.1 (1.5-3.8)	0.002
Water balance ≤ 74%	100.0	55.9	-	-	0.001
Saturation without oxygen support ≤ 92%	90.9	58.1	15.8 (13.8-139)	2.4 (1.5-3.8)	0.003
Leukocytes ≤ 3.1 × 109/L	50.0	100.0	-	-	0.000004
Platelets ≤ 168 × 109/L	100.0	59.5	-	-	0.0003
Potassium > 4.7 mmol/L	66.7	91.4	15.5 (3.2-75.9)	5.8 (2.1-15.9)	0.0002
Albumin ≤ 30 g/L	90.9	54.3	12.5 (1.4-108.2)	2.1 (1.4-3.1)	0.007
Creatinine > 74 μmol/L	75.0	65.7	5.1 (1.2-22.2)	2.0 (1.2-3.5)	0.023
pH ≤ 7.36	58.3	85.3	8.2 (1.8-36.0)	4.0 (1.6-10.2)	0.003
HCO3- ≤ 22.2	90.0	61.5	14.4 (10.6-131.5)	2.3 (1.4-4.0)	0.006
Glasgow Coma Scale ≤ 13 points	58.3	77.8	4.9 (1.2-19.7)	2.6 (1.5-5.7)	0.019
SOFA > 2 points	100.0	51.5	-	-	0.002
MV-RR > 20 per minute	80.0	83.3	20 (0.9-429.9)	4.8 (0.8-30.3)	0.036
Oxygen therapy via face mask	81.8	78.6	1.9 (1.2-3.1)	6.2 (1.2-32.6)	0.020
Need for mechanical ventilation	41.7	86.8	4.7 (1.1-20.8)	3.2 (1.1-9.1)	0.032
Treatment with bDMARD	15.4	100.0	-	-	0.015
Transfusion of FFP	50.0	83.3	5.0 (1.2-20.9)	3.0 (1.2-7.6)	0.021

Se: Sensitivity; Sp: Specificity; CI: Confidence interval; OR: Odds ratio; RR: Respiratory rate; SOFA: Sequential Organ Failure Assessment; MV: Mechanical ventilation; bDMAD: Biological disease-modifying antirheumatic drugs; FFP: Fresh frozen plasma.

Table 3 Predictors of lethal outcome (data on the third day of staying in the intensive care unit), median (interquartile range)

Predictor	Se	Sp	OR (95%CI)	RR (95%CI)	Р value
Leukocytes ≤ 4.0 × 109/L	60.0	97.1	46.5 (4.4-492.1)	7.9 (3.0-21.0)	0.00001
Platelets ≤ 63 × 109/L	70.0	88.2	17.5 (3.2-96.6)	7.0 (2.2-22.5)	0.0002
Hemoglobin ≤ 87 g/L	80.0	82.4	18.7 (3.1-111.0)	8.6 (2.1-35.2)	0.0002
CRP > 129 mg/L	66.7	78.8	8.0 (1.6-40.2)	4.5 (1.3-15.1)	0.009
Triglycerides > 2.45 mmol/L	75.0	81.8	13.5 (0.9-207.6)	3.0 (0.8-44.0)	0.039
Albumin ≤ 28 g/L	77.8	86.2	21.9 (3.3-145.2)	8.6 (2.1-35.1)	0.0002
Creatinine > 83.5 μmol/L	66.7	83.5	11.6 (2.2-62.2)	5.1 (1.5-16.9)	0.002
pH ≤ 7.38	55.6	89.7	12.1 (2.1-71.1)	4.7 (1.6-13.5)	0.004
Glasgow Coma Scale score ≤ 10 points	70.0	91.2	24.1 (4.0-145.6)	7.9 (2.5-25.2)	0.00005
SOFA > 2 points	100.0	71.0	-	-	0.00009
Mechanical ventilation	70.0	93.1	31.5 (4.4-226.5)	7.8 (2.5-24.1)	0.00004
No IVIG treatment	96.9	27.3	11.6 (1.1-127.3)	3.2 (0.6-17.5)	0.018
Blood transfusion	27.3	21.9	0.11 (0.02-0.5)	0.2 (1.1-3.3)	0.003

Se: Sensitivity; Sp: Specificity; CI: Confidence interval; OR: Odds ratio; RR: Respiratory rate; CRP: С-reactive protein; SOFA: Sequential Organ Failure Assessment; IVIG: Intravenous immunoglobulin.

Table 4 Predictors of lethal outcome (data on the fifth day of staying in the intensive care unit), median (interquartile range)

Predictor	Se	Sp	OR (95%CI)	RR (95%CI)	Р value
Maximum HR > 97 per minute	91.7	18.5	2.5 (0.3-24.1)	2.0 (0.3-12.8)	0.039
CRP > 28 mg/L	88.9	85.7	48.0 (4.3-535.3)	13.8 (2.0-96.3)	0.0001
Triglycerides > 2.3 mmol/L	100.0	63.6	-	-	0.029
Creatinine > 58 μmol/L	80.0	69.6	9.1 (1.5-54.5)	4.8 (1.2-19.3)	0.009
Fibrinogen > 3.3 g/L	80.0	95.5	84.0 (6.7-1060)	10.2 (2.7-39.2)	0.00001
Glasgow coma scale score ≤ 14 points	90.0	69.6	20.6 (2.2-195.0)	9.6 (1.4-67.2)	0.002
SOFA > 2 points	100.0	70.0	-	-	0.0003
Need in MV	54.5	91.3	12.6 (1.9-82.1)	3.9 (1.6-9.4)	0.002
Need in vasopressors	27.3	95.7	7.9 (0.7-91.3)	2.8 (1.2-6.4)	0.038
Compliance with the MAS criteria EULAR/ACR/PRINTO 2016	55.6	86.4	7.9 (1.3-47.5)	3.6 (1.3-10.2)	0.015
No anticoagulant therapy	82.6	72.7	12.7 (2.3-70.0)	2.6 (1.1-5.9)	0.002
Blood transfusion	36.4	95.7	12.6 (1.2-131.9)	2.9 (1.4-6.4)	0.009
Transfusion of FFP	36.4	87.0	3.8 (0.7-21.4)	2.2 (0.9-5.5)	0.021

Se: Sensitivity; Sp: Specificity; CI: Confidence interval; OR: Odds ratio; RR: Respiratory rate; HR: Heart rate; CRP: C-reactive protein; SOFA: Sequential Organ Failure Assessment; MV: Mechanical ventilation; MAS: Macrophage activation syndrome; EULAR: European League Against Rheumatism; ACR: American College of Rheumatology; PRINTO: Paediatric Rheumatology International Trials Organisation; FFP: Fresh frozen plasma.

Table 5 Predictors of lethal outcome (data on the seventh day of staying in the intensive care unit), median (interquartile range)

Predictor	Se	Sp	OR (95%CI)	RR (95%CI)	Р value
Maximum HR > 115 per minute	70.0	91.7	25.7 (2.2-298.5)	4.1 (1.5-11.5)	0.003
CRP > 19.1 mg/L	100.0	92.3	-	-	0.00003
Albumin ≤ 35 g/L	88.9	61.5	12.8 (1.2-135.6)	5.5 (0.8-36.9)	0.018
Total protein ≤ 55 g/L	88.9	84.6	44.0 (3.4-573.4)	9.6 (1.4-64.3)	0.0007
Glasgow Coma Scale score ≤ 12 points	70.0	92.3	28.0 (2.4-323.7)	4.4 (1.5-12.5)	0.002
SOFA > 3 points	100.0	83.3	-	-	0.00009
Need in MV	70.0	91.7	25.7 (2.2-298.5)	4.1 (1.5-11.5)	0.003
Meeting the EULAR/ACR/PRINTO 2016 criteria	44.4	84.6	4.4 (0.6-32.5)	2.1 (0.9-5.4)	0.015
Treatment with bDMARD	30.0	100.0	-	-	0.034
Anticoagulant therapy	30.0	15.4	0.08 (0.01-0.59)	0.28 (0.1-0.8)	0.008

Se: Sensitivity; Sp: Specificity; CI: Confidence interval; OR: Odds ratio; RR: Respiratory rate; HR: Heart rate; CRP: C-reactive protein; SOFA: Sequential Organ Failure Assessment; MV: Mechanical ventilation; EULAR: European League Against Rheumatism; ACR: American College of Rheumatology; PRINTO: Paediatric Rheumatology International Trials Organisation; bDMARD: Biological disease-modifying antirheumatic drugs.