ISSN 1006-298X      CN 32-1425/R

Chinese Journal of Nephrology, Dialysis & Transplantation

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Persistent inflammationimmunosuppressioncatabolism syndrome in patients with systemic lupus erythematosus

  

  • Online:2020-04-28 Published:2020-05-08

Abstract:

Objective:This  study was aimed to evaluate  clinical characteristics and prognosis of systemic lupus erythematosus (SLE) with persistent inflammationimmunosuppressioncatabolism syndrome (PICS).
Methodology:We retrospectively analyzed the patients with SLE who were admitted to the renal ICU for over 14 days of Jinling Hospital from July 2010 to July 2018.According to  diagnostic criteria of PICS,we divided the  patients into  PICS group and a nonPICS group.We compared the clinical feature and prognosis,and also performed a multivariate COX regression analysis on the risk factors for death on SLE patients with PICS.
Results:A total of 96 SLE patients met the inclusion  standard of this study,including 61  PICS patients  and 35   nonPICS  patients.The PICS group patients had a longer length of stay in ICU,higher inflammatory indicators such as CRP,PCT and IL6,and lower immune function such as total lymphocyte count,CD3+,CD4+,CD8+ and CD20+ lymphocytes than these of  nonPICS group (P<001).Hemoglobin,platelet,serum creatinine,serum blood urea nitrogen and SLEDAI score in PICS group were lower than those in  nonPICS group (P<005).The  PICS combined with sepsis,ARDS,mechanical ventilation,grampositive bacteria,negative bacteria,fungus,and superinfection were higher than nonPICS group (P<005).The longterm survival rate was 5082% in the PICS group and 8571% in the nonPICS group until January 2020.The renal survial rate was 3115% in  PICS group and 4571% in  nonPICS group.Multivariate COX regression found that APACHEⅡ score and total lymphocyte count during ICU were independent risk factors for death in SLE patients with PICS.
Conclusion:Patients with SLE complicated with PICS had longer ICU stay,higher risk of secondary infection,significantly lower survival rate than nonPICS patients.PICS patients with high APACHEⅡ score and low total lymphocyte count had poor prognosis