Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictors of lethal outcome in patients with immunoinflammatory diseases hospitalized in the intensive care unit
Natalia N Abramova, Ilia S Avrusin, Olga P Kozlova, Liudmila A Firsova, Anastasia G Kuleshova, Gleb V Kondratiev, Dmitry O Ivanov, Yury S Aleksandrovich, Mikhail M Kostik
Natalia N Abramova, Yury S Aleksandrovich, Department of Anesthesiology, Resuscitation and Emergency Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Ilia S Avrusin, Anastasia G Kuleshova, Mikhail M Kostik, Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Olga P Kozlova, Department of Clinical Mycology, Allergology, and Immunology, North-Western State Medical University Named after I.I. Mechnikov, Saint Petersburg 191015, Russia
Liudmila A Firsova, Department of Propaedeutics of Childhood Diseases, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Gleb V Kondratiev, Department of Oncology, Pediatric Oncology and Radiation Therapy, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Dmitry O Ivanov, Department of Neonatology, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Co-first authors: Natalia N Abramova and Ilia S Avrusin.
Author contributions: Abramova NN, Avrusin IS, and Kostik MM contributed to the conceptualization, writing, reviewing, and editing; Abramova NN and Avrusin IS contributed equally to this article as co-first authors of this manuscript; Ivanov DO, Aleksandrovich Yu S, and Kostik MM contributed to the methodology; Firsova LA and Kuleshova AG contributed to the software, resources, and data curation; Kondratiev GV, Firsova LA, and Kuleshova AG contributed to the validation; Avrusin IS and Kostik MM contributed to the formal analysis; Abramova NN and Kozlova OP contributed to the investigation and visualization; Avrusin IS, Aleksandrovich YS, and Kostik MM contributed to writing the first draft, funding, supervision, and project administration; All authors read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Saint Petersburg State Pediatric Medical University, approval No. 03/09 22 March 2021.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mikhail M Kostik, MD, PhD, Professor, Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, 2 Lytovskaya Street, Saint-Petersburg 194100, Russia,
kost-mikhail@yandex.ru
Received: September 30, 2024
Revised: January 20, 2025
Accepted: February 6, 2025
Published online: September 9, 2025
Processing time: 291 Days and 20.2 Hours
BACKGROUND
Systemic immunoinflammatory diseases can affect multiple systems and organs. They have a severe course and severe complications, causing multiple organ failure and death. Quite often these patients are required to be hospitalized in the intensive care unit (ICU). Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.
AIM
To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.
METHODS
The retrospective continuous cohort study included 51 patients (23 males, 28 females) with immunoinflammatory diseases, including multisystem inflammatory syndrome associated with coronavirus disease 2019 (n = 18), systemic rheumatic diseases (n = 24), and generalized infections (n = 9). The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.
RESULTS
Thirteen patients (25.5%) died within 39 (17; 62) days after ICU admission. Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived (30 days vs 7 days, P = 0.013) and had a longer stay in the ICU (30 days vs 6 days, P = 0.003). The main predictors of the fatal outcome were age > 162 months [odds ratio (OR) = 10.7; 95% confidence interval (CI): 2.4-47.2], P = 0.0006], time to ICU admission > 26 days from the disease onset (OR = 12.0; 95%CI: 2.6-55.3, P = 0.008), preceding immune suppression treatment (OR = 6.2; 95%CI: 1.6-24.0, P = 0.013), invasive mycosis during the ICU stay (OR = 18.8; 95%CI: 1.9-184.1, P = 0.0005), systemic rheumatic diseases (OR = 7.2; 95%CI: 1.7-31.1, P = 0.004), and ICU stay over 15 days (OR = 19.1; 95%CI: 4.0-91.8, P = 0.00003). Multiple regression analysis (r2 = 0.422, P < 0.000002) identified two predictors of the fatal outcomes: Systemic rheumatic diseases (P = 0.015) and ICU stay over 15 days (P = 0.00002).
CONCLUSION
Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program. Avoiding ICU stays for patients with systemic rheumatic diseases, close monitoring, and preventing invasive mycosis might improve the outcome in children with systemic immune-mediated diseases.
Core Tip: Systemic immunoinflammatory diseases are characterized by the simultaneous involvement of different organs and systems with a high risk of a fatal outcome. These patients are often required to be admitted to the intensive care unit (ICU). Early predictors of fatal outcomes after ICU admission may be modifiable to improve the outcomes. Older age, longer time before ICU admission, longer stay in the ICU, preceding immune suppression therapy, and development of invasive mycosis are predictors of unfavorable outcomes. Preventive measures should be set up to decrease the lethality in such patients.
