In a matched cohort study of 50,920 intensive care unit (ICU) admissions from the United States Multiparameter Critical Care Intelligent Monitoring-IV database (2008–2019), investigators examined whether comorbid systemic lupus erythematosus (SLE) adversely affects intensive-care outcomes. After matching SLE cases to controls to reduce confounding, groups were compared with Wilcoxon and Pearson χ² tests. Time-to-event differences were evaluated via log-rank testing, and risk factors were assessed using univariate and multivariable Cox regression. A mediation framework then tested whether specific physiologic variables explained SLE’s survival effect, with renal indices (creatinine, urine output) and Sequential Organ Failure Assessment (SOFA) considered alongside hematologic parameters.
SLE was associated with significantly lower 180-day survival versus controls (HR 1.485, P=0.015). Although hemoglobin, platelets, white blood cells, creatinine, urine output, and SOFA were significant in univariate models, only creatinine and urine output remained significant in adjusted analyses. Mediation indicated renal function (creatinine) as a key pathway linking SLE to mortality risk. Among patients with SLE, glucocorticoid use attenuated the excess risk (HR 1.482, P=0.095; not significant), whereas those without steroids had worse survival (HR 1.660, P=0.027), suggesting a potential protective association. Overall, SLE appears to diminish ICU survival largely via renal dysfunction.
Reference: Zhang H, Ding Y, Zhang H, Zhou J, Zhou W. Systemic lupus erythematosus reduces survival of ICU patients mediated by renal dysfunction: retrospective study of critically ill patients. BMC Rheumatol. 2025. doi: 10.1186/s41927-025-00600-0. Epub ahead of print.
Link: https://link.springer.com/article/10.1186/s41927-025-00600-0
