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Master Thesis

Profil et pronostic des myopathies inflammatoires en unité de soins intensifs : une étude rétrospective et multicentrique

Abstract : Introduction: Idiopathic inflammatory myopathies (IIM) are life-threatening diseases which can require an admission into intensive care unit (ICU) during their evolution. Due to the low incidence of IIM, not many studies exist about such patients. Our aim was to investigate the clinical features and the prognostics of patients with IIM after an admission in ICU. Study design and methods: We performed an observational, retrospective, multicentric study in France. We record every patient which an IMM who was admitted to the ICU between 1er January 2015 and 31 December 2020. We collected the data about clinical characteristics, causes of admission, organ dysfunction, and mortality. Result: 43 patients (62.8% women, median age 66 years (interquartile range (IQR), 47-75)) were included in this study. In our cohort, the repartition of the different IMM was as follow: dermatomyositis (DM) 39,5%, anti-synthetase syndrome (ASyS) 18,6%, immune-mediated necrotizing myopathies (IMNM) 14%, and inclusion body myositis (IBM) 4.7%. The median duration from the diagnosis of the IIM to ICU admission was 6 months (IQR, 0–21,5 months). Reasons for ICU admission were acute exacerbation of IIM (72%) or infection (70%), and the coexistence of both (49%). Pneumonia accounted for 74% of the infection. Muscular manifestation (35%) and acute respiratory failure (35%) flare-up were the most frequent exacerbation of IIM. Median APACHE II on day-1 was 9 (IQR 5,5-16,5). Mechanical ventilation was required in 44% cases, vasopressors in 30% and renal replacement therapy in 7%. ICU admission and 90 days mortality rates were 28% (n=12/43) and 37.2% (n=16/43), respectively. Factors associated with increased early admission ICU included muscle involvement at diagnosis (p<0.01), muscle exacerbation at admission (p<0.01), and a high rate of creatinine phosphokinase (CPK) (p<0.01). The mortality rate at 30 days of early admission patients was higher than later admission (p=0.01, Hazard ratio 4.2). Conclusions: IIM are severe pathologies. The patients are at risk for being hospitalized in ICU especially in the first months of follow-up. The main reasons being infections, acute exacerbation of muscular manifestation, and respiratory failure. The mortality rate in ICU was 28% and increase around 37.2% at 90 days. Therefore, it is important to quickly manage patients with IIM, especially at the time of diagnosis, to prevent them from going into ICU.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03629343
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Monday, April 4, 2022 - 12:03:36 PM
Last modification on : Wednesday, April 6, 2022 - 3:33:13 AM

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Kevin Gourbeyre-Masson. Profil et pronostic des myopathies inflammatoires en unité de soins intensifs : une étude rétrospective et multicentrique. Médecine humaine et pathologie. 2021. ⟨dumas-03629343⟩

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