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Zeitschrift für Rheumatologie

, Volume 78, Issue 10, pp 925–931 | Cite as

Epidemiologie und Outcome von Rheumapatienten auf der Intensivstation

  • Gernot KeyßerEmail author
Leitthema
  • 61 Downloads

Zusammenfassung

Patienten mit rheumatischen Erkrankungen haben ein höheres Risiko, auf eine Intensivstation (ITS) aufgenommen zu werden, als Vergleichspersonen ohne diese Erkrankungen. Häufige Indikationen sind neben kardiovaskulären Ereignissen infektiöse Komplikationen. Bei autoimmunen Systemerkrankungen wie dem systemischen Lupus erythematodes (SLE) und der Granulomatose mit Polyangiitis (GPA) kommt es nicht selten erst während der intensivmedizinischen Behandlung zur Diagnosestellung. Auch Schübe dieser Erkrankungen können die Patienten intensivpflichtig werden lassen. Die Sterblichkeit von Patienten mit rheumatischen Erkrankungen ist auf ITS im Vergleich zu Kontrollkollektiven erhöht, v. a. dann, wenn infektiöse Ereignisse zur Aufnahme führten. Eine Behandlung mit Steroiden ist mit einem erhöhten Risiko einer ITS-Aufnahme und einer schlechteren Prognose quoad vitam assoziiert, während konventionelle und biologische DMARDs („disease modifying antirheumatic drugs“) präventiv im Hinblick auf eine ITS-Behandlung wirken, verglichen mit rheumatologischen Patienten, die diese Medikamente nicht erhalten. Von den in der Intensivmedizin zur Prognoseeinschätzung verwendeten Scoresystemen ist der APACHE(Acute Physiology And Chronic Health Evaluation)-II-Score für Patienten mit rheumatischen Erkrankungen am besten untersucht und bildet deren spezifische Situation möglicherweise besser ab als andere Scoresysteme.

Schlüsselwörter

Rheumatische Erkrankungen Intensivmedizinische Behandlung Infektiöse Komplikationen Komorbidität Mortalität 

Epidemiology and outcome of patients with rheumatic diseases in the intensive care unit

Abstract

Patients with rheumatic diseases have an increased risk for admission to an intensive care unit (ICU) compared with individuals without these diseases. Besides cardiovascular events, infection complications are frequently the reason for ICU treatment. For autoimmune systemic diseases, such as systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (GPA), it is not uncommon for the disease to be first diagnosed during intensive medical care. In addition, flares of these diseases can necessitate ICU admission of the patients. The mortality of patients with rheumatic diseases on the ICU is increased compared with control collectives, especially in patients suffering from life-threatening infections. Treatment with corticosteroids is associated with an increased risk for ICU admission as well as a poorer survival rate. In contrast, patients treated with conventional and biologic disease-modifying anti-rheumatic drugs (DMARD) are less likely to need ICU treatment, compared with rheumatism patients without these medications. Among the established scoring systems applied to estimate the prognosis of ICU patients, the APACHE II score is the best investigated system in patients suffering from rheumatic diseases. This score probably reflects the condition of these patients better than other scoring systems.

Keywords

Rheumatic diseases Intensive care treatment Infectious complications Comorbidity Mortality 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Keyßer gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department für Innere Medizin, Klinik für Innere Medizin IIUniversitätsklinikum HalleHalle (Saale)Deutschland

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