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Background <p>Systemic autoimmune rheumatic diseases (SARDs) contain various disease spectrums with complex clinical manifestations. The management of life-threatening SARDs requiring intensive care is a challenge due to the complexity and the lack of rheumatologist support. The first independent rheumatology intensive care unit (Rh-ICU) throughout the China was established in our center after COVID-19 pandemic. We are working to build a more precise prognostic model with an immunology perspective to better understand and manage the special critically ill SARDs.</p> Methods <p>A retrospective study was conducted in the patients admitted into Rh-ICU. The clinical data of Rh-ICU first admission was collected and analyzed. Survival analysis was performed in derivation cohort (<i>n</i> = 305) and result was verified in validation cohort (<i>n</i> = 114).</p> Results <p>Systemic lupus erythematosus (SLE) was the most common disease of Rh-ICU cohort followed by anti-MDA5 dermatomyositis (MDA5 + DM), antisynthetase syndrome, and others. COX analysis identified T-lymphopenia (T-cell &lt; 700 cells/ul) and APACHE-II score were independent prognostic factors for 28-day ICU mortality. Moreover, T-lymphopenia had been proved to be a robust predictor in different models across the board. Kaplan–Meier analysis showed significant inferior survival of T-lymphopenia patients in both derivation and validation cohort. The adverse prognosis of T-lymphopenia was also confirmed among disease entities such as SLE and MDA5 + DM. In addition, T-lymphopenia patients needed more invasive procedures and had a significantly higher ICU acquired infection rate.</p> Conclusions <p>T-lymphopenia was proven to be a simple but strong prognostic predictor for 28-day mortality and more severe diseases in a unique Rh-ICU cohort, which may help to improve the management of critically ill SARDs.</p>

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Peripheral T-lymphopenia implicated unfavorable prognosis in patients with critically ill systemic autoimmune rheumatic diseases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Yang Zhang,
  • Zhiwei Chen,
  • Jie Chen,
  • Liyang Gu,
  • Liling Zhao,
  • Yiyangzi Ma,
  • Wenwen Xu,
  • Cuiying Xie,
  • Qing Wei,
  • Xiaodong Wang,
  • Shuang Ye,
  • Yakai Fu,
  • Yi Chen

摘要

Background

Systemic autoimmune rheumatic diseases (SARDs) contain various disease spectrums with complex clinical manifestations. The management of life-threatening SARDs requiring intensive care is a challenge due to the complexity and the lack of rheumatologist support. The first independent rheumatology intensive care unit (Rh-ICU) throughout the China was established in our center after COVID-19 pandemic. We are working to build a more precise prognostic model with an immunology perspective to better understand and manage the special critically ill SARDs.

Methods

A retrospective study was conducted in the patients admitted into Rh-ICU. The clinical data of Rh-ICU first admission was collected and analyzed. Survival analysis was performed in derivation cohort (n = 305) and result was verified in validation cohort (n = 114).

Results

Systemic lupus erythematosus (SLE) was the most common disease of Rh-ICU cohort followed by anti-MDA5 dermatomyositis (MDA5 + DM), antisynthetase syndrome, and others. COX analysis identified T-lymphopenia (T-cell < 700 cells/ul) and APACHE-II score were independent prognostic factors for 28-day ICU mortality. Moreover, T-lymphopenia had been proved to be a robust predictor in different models across the board. Kaplan–Meier analysis showed significant inferior survival of T-lymphopenia patients in both derivation and validation cohort. The adverse prognosis of T-lymphopenia was also confirmed among disease entities such as SLE and MDA5 + DM. In addition, T-lymphopenia patients needed more invasive procedures and had a significantly higher ICU acquired infection rate.

Conclusions

T-lymphopenia was proven to be a simple but strong prognostic predictor for 28-day mortality and more severe diseases in a unique Rh-ICU cohort, which may help to improve the management of critically ill SARDs.