Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database

Jin Wan; Xiaoyu Cao; Yaran Yang

doi:10.1007/s10067-024-07280-0

Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database

Clin Rheumatol. 2024 Dec 24. doi: 10.1007/s10067-024-07280-0. Online ahead of print.

Authors

Jin Wan¹, Xiaoyu Cao², Yaran Yang²

Affiliations

¹ Rheumatology and Immunology Department, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No. 119, West South Fourth Ring Road, 100070, Beijing, China. wanjin_tiantan@163.com.
² Rheumatology and Immunology Department, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No. 119, West South Fourth Ring Road, 100070, Beijing, China.

PMID: 39715962
DOI: 10.1007/s10067-024-07280-0

Abstract

Inflammatory response is a natural protective response in infection or injury. The immune imbalance of rheumatoid arthritis (RA) patients and the use of anti-rheumatic immune drugs may affect the inflammatory response process of shock. The evidence of the impact of RA on short-time mortality in shock patients is limited. This study was a retrospective observational study from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Patients diagnosed with shock were selected from the database. The primary outcome was in-hospital mortality. Binary logistic regression analysis was used to explore the association between RA and in-hospital mortality. Subgroup analysis of the association between in-hospital mortality and RA was performed in septic shock, cardiogenic shock, and other types of shock. A total of 8233 ICU patients with shock were identified. After adjusting for confounding variables, RA was associated with a lower risk of in-hospital mortality (OR, 0.58; 95% CI, 0.38-0.91). The results of the subgroup analysis showed that RA was associated with a decreased risk of in-hospital death in the septic shock group but not in cardiogenic shock or other types of shock. RA was associated with a lower risk of in-hospital death in shock patients. This association was only observed in septic shock but not in cardiogenic shock and other types of shock. Key Points • Rheumatoid arthritis (RA) is associated with a lower risk of in-hospital mortality in ICU patients with shock, particularly in those with septic shock. • This study utilized propensity score matching to accurately compare outcomes between RA and non-RA shock patients, ensuring balanced baseline characteristics. • Findings suggest that the immune modulation inherent to RA or the impact of anti-rheumatic drugs might influence the survival outcomes in shock scenarios. • The protective effect of RA on in-hospital mortality was not observed in patients with cardiogenic shock or other types of shock, indicating a specific interaction in septic shock contexts.

Keywords: In-hospital mortality; Rheumatic arthritis; Septic shock; Shock.