紅斑性狼瘡病人至急診就診之原因與預後之分析－－北台灣某醫學中心之經驗

Analysis of causes, prognosis and factors associated with mortality in patients with systemic lupus erythematosus for emergency call in a medical center of northern Taiwan

目的：針對因急性內科疾病於急診就診的紅斑性狼瘡病患，評估並尋找可能影響病人是否需要住院的因素，並分析和死亡相關的危險因子。方法：我們檢視曾於西元2002年六月至西元2005年五月之間於台大急診就診的紅斑性狼瘡病患的醫療紀錄。A組的130位病人包含於急診死亡的病患，須要住院的病患，於急診離院卻又於短時間因相同症狀再度回到急診的病患，以及於急診離院後，門診主治醫師評估需要住院的病患。其他79位病人歸類為B組。結果：47.8%病人有發燒。除了發燒，病患來急診就診最常見原因為腸胃道症狀，有54位（25.8%）病人。A組病人有較高的SLICC scorc（2.19 ± 2.65 vs. 1.29 ± 1.72）和SLEDAI-2K（9.65 ± 6.08 vs. 5.83 ± 5.71），較高的Anti-RNP陽性率，較多發燒病患，較高的CRP值，及較多比率的病人於就診前一個月內曾住院或最近需要較大量的類回醇。但A組血色素及血小板數較低。A組死亡者相對於存活者有較多比率有抗磷脂症候群（15.79% vs. 3.6%），血氧濃度<95%的比率較多（31.6% vs. 7.2%），血色素及淋巴球數目較低，SLICC score、血清肌酸苷，及CRP較高。最常見死亡原因為敗血性休克（12/19），但其中8位是死於後續的院內感染。結論：本研究發現某些因素和紅斑性狼瘡病人是否需住院及是否死亡有關。在這些需要住院的病患中，導致死亡的最常見原因為院內感染。

Objective: To identify causes of visiting Emergency Department (ED), factors associated with need for hospitalization, and risk factors of mortality in systemic lupus erythematosus (SLE) patients. Methods: Medical records were reviewed in 209 SLE patients who ever visited our ED from June 2002 to May 2005. Group A consisted of 130 patients who deceased at ED, or required hospitalization or second visit to ED. Patients not fulfilling the criteria of group A were included in group B. Results: Fever was noted in 47.8% of patients. Aside from fever, the main cause of visiting ED was gastrointestinal tract symptoms in 54 (25.8%) patients. Patients in group A had higher SLICC score (2.19 ± 2.65 vs. 1.29 ± 1.72) and SLEDAJ-2K at ED (9.65 ± 6.08 vs. 5.83 ± 5.71). We also observed more frequent positive anti-RNP, fever, C-reactive protein (CRP), and increase in steroid dosage or hospitalization within 1 month before visiting ED in group A, but hemoglobin level and platelet count were lower. Among deceased patients, higher SLICC score, more antiphospholipid syndrome (15.8% vs. 3.6%), decreased oxygen saturation (defined as SpO2 < 95%) (31.6% vs. 7.2%), worse anemia and lymphopenia, and higher level of serum creatinine and CRP were observed. The most common cause of mortality in group A was septic shock in 12 of 19 patients and 8 of them died of nosocomial infections. Conclusions: Various factors were associated with the requirement of hospitalization and short-term mortality in SLE patients visited ED. Among these patients, the major cause of death was subsequent nosocomial infections.