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Aim of the work To describe the clinical features and prognostic factors in patients with rheumatic diseases (RDs) admitted to the intensive care unit (ICU). Patients and methods Clinical data of 33 RD patients admitted to the ICU of Shenzhen Baoan Hospital were retrospectively analyzed regarding the causes for admission, medications received, duration of stay and the management required. Disease severity of the patients was assessed using the acute physiology and chronic health evaluation (APACHE-II) score. Results The diagnoses of the patients included 16 (48.5%) systemic lupus erythematosus (SLE), 7 (21.2%) systemic vasculitis, 4 (12.1%) rheumatoid arthritis; 3 (9.1%) polymyositis/dermatomyositis; 2 (6.1%) Sjogren’s syndrome and 1 (3%) with systemic sclerosis. The mean APACHE-II score was mean 16.1 ± 7.3. The main cause for ICU admission was infection in 12 (36.4%) patients, primary disease worsening in 8 (24.2%), infection associated with disease activity in 9 (27.3%) and 4 (12.1%) cases were hospitalized for other disease processes (including 1 case of subarachnoid hemorrhage, 1 case of acute myocardial infarction and 2 with hypovolemic shock). 31 (93.9%) had more than one organ involved. Mortality was 51.5% (17 cases); including 9 (27.3%) deaths from infection, 5 (15.2%) from primary diseases, and 3 (9.1%) from other causes. Primary disease worsening and APACHE-II score were significantly increased in the mortality cases (33.3% and 20 ± 7.1) compared to survivors (13.3% and 10 ± 1.2) (p = 0.017 and 0.0001 respectively). Conclusion SLE was the most frequent cause of ICU admission; infections are the leading causes prompting admission. RDs patients often had multi-organ involvement with a high mortality rate.

Recurrent pregnancy loss (RPL) is the most common manifestation of anti-phospholipid syndrome (APS), and activated CD4+ T cells are involved in its pathogenesis. Treatment with low-molecular weight heparin (LMWH) and aspirin combination improves pregnancy outcome, however, its mechanism of action is unclear. We investigated the effect of this therapy on Th1/Th2 cells in 89 patients with APS-RPL. The results showed that serum cytokine levels, T cell phenotypes, and transcription factors' gene expression levels representing Th1 responses were higher, whereas those representing Th2 responses were lower in patients with APS-RPL at the time of early pregnancy. This Th1-bias was reversed in patients who had live birth after receiving the combination therapy at the time of delivery. Patients with miscarriages continued to exhibit Th1-bias. In conclusion, these data support a role of Th1-bias in the pathogenesis of APS-RPL and suggest restoring T-cell phenotype as a new immunomodulatory mechanism of LMWH/aspirin combination.