Intensive care unit admission and mortality in rheumatic diseases

Fedorchenko Y. Auyezkhankyzy D. Permenov B.A. Zimba O. Zaiats L.
December 2025 Springer Science and Business Media Deutschland GmbH

Rheumatology International
2025 #45 Issue 12

Rheumatic diseases (RDs) comprise a heterogeneous group of autoimmune and autoinflammatory disorders marked by systemic inflammation, immune dysregulation, and progressive multiorgan damage. Despite advances in immunopathology and targeted therapies, acute complications requiring intensive care unit (ICU) management remain a major cause of morbidity and mortality in RDs. Infections and disease flares are the leading triggers of ICU admission, while mortality rates range from 14% to 60%, depending on disease severity and organ failure. Catastrophic antiphospholipid syndrome, pulmonary–renal syndrome, macrophage activation syndrome, and scleroderma renal crisis represent the most lethal rheumatologic emergencies. Systemic lupus erythematosus and idiopathic inflammatory myopathies exhibit the highest ICU mortality, followed by systemic sclerosis, rheumatoid arthritis, and primary Sjögren syndrome. Adverse outcomes are compounded by corticosteroid exposure, chronic immunosuppression, and respiratory or renal failure. Although biologic agents, intravenous immunoglobulin, and extracorporeal support have improved selected outcomes, survival remains inconsistent. Early recognition, multidisciplinary management, and standardized, evidence-based care pathways are essential to optimize outcomes and reduce ICU mortality in critically-ill patients with RDs.

Autoimmune emergencies , Catastrophic antiphospholipid syndrome , Intensive care unit , Mortality , Multiorgan failure , Rheumatic diseases , Rheumatoid arthritis , Systemic lupus erythematosus

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Department of Pathophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76018, Ukraine
Department of Emergency Medicine and Nursing, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
Department of Cardiac Surgery Anesthesiology and Intensive Care, Heart Center Shymkent, Shymkent, Kazakhstan
Department of Social Health Insurance and Public Health, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
Department of Internal Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, Kazakhstan
Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Kraków, Kraków, Poland
National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Department of Pathophysiology
Department of Emergency Medicine and Nursing
Department of Cardiac Surgery Anesthesiology and Intensive Care
Department of Social Health Insurance and Public Health
Department of Internal Medicine
Department of Rheumatology
National Institute of Geriatrics
Department of Internal Medicine N2

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