Respiratory failure outcomes of rheumatoid arteritis and other vasculitis in the intensive care unit prepandemic and pandemic

The pandemic may raise the risk of rheumatoid arteritis (RA) and vasculitis. As predicted, the pandemic may increase mortality from acute respiratory failure (ARF) requiring ICU treatment. We evaluated RA and vasculitis death rates in ARF ICU admissions before and during the pandemic. Patients and methods A teaching hospital's level 3 respiratory ICU conducted this retrospective observational cross-sectional study between 2017 and 2022. Pre-pandemic and Pandemic period were defined 2017–2019, and 2020–2022 respectively. All RA and vasculitis-previously diagnosed ICU patients with ARF were included. Demographics, comorbidities, respiratory support, mechanical ventilation, ICU severity score (APACHE II), and hospitalization reasons were recorded. Data were compared among study group. Patients were sub grouped as survivor -nonsurvivors and were compared. Logistic regression test were assessed for mortality predictors. Results Before the pandemic, and Pandemic respectively 64 (1.65%) of 3867 patients and 87 (1.42%) of 6099 had RA, vasculitis(p = 0.36). Age, gender, comorbidities, and ICU admission reasons were similar pre- and post-pandemic. The pandemic has 12 Covid-19 cases (14%). APACHE II score, invasive (IMV) and non-invasive mechanical ventilation (NIMV) rates at ICU admission were similar in the pre-pandemic and pandemic groups, but total NIMV (NIMV alone and both IMV and NIMV) rates were significantly higher in the pre-pandemic group (59% vs 38%, respectively, p = 0.011), and mortality rates were similar (n = 16, 24.6% vs n = 26, 30.2%, respectively, p = 0.45). The nonsurvivors had a higher median APACHE II score (24 vs 20, p = 0.001), a greater rate of IMV administration (93% vs 28%), and a lower incidence of just NIMV administration (2.4% vs 38%). Patients who died, had 33% NIV failure compared to 15% (p = 0.010). IMV application had a mortality risk OR of 32.71 (95% CI: 9.41–113.70; p < 0.001). Conclusion Although the pandemic does not lead to an additional mortality risk for patients with RA and vasculitis in the ICU, the mortality risk may increase 32-fold in patients with ARF who need intubation.