Characteristics and outcome of adults with severe autoimmune hemolytic anemia admitted to the intensive care unit: Results from a large French observational study

Clara Pouchelon (1, 2) , Charlotte Lafont (3, 4) , Antoine Lafarge (5) , Thibault Comont (6, 7) , Etienne Riviere (8) , David Boutboul (9) , Claire Fieschi (9) , Antoine Dossier (10) , Sylvain Audia (11) , Julien Vaidie , Marc Ruivard (12, 13) , Delphine Gobert (14) , Guillaume Bonnard (15) , Julie Graveleau (16) , Matthieu Mahevas (17, 15) , Bertrand Godeau (18) , Marc Michel

1 CHU Pitié-Salpêtrière [AP-HP]
2 I3 - Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière]
3 IPGP (UMR_7154) - Institut de Physique du Globe de Paris
4 U955 Inserm - UPEC - IMRB - CEPIA/"Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health" [Créteil]
5 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
6 Service Hématologie - IUCT-Oncopole [CHU Toulouse]
7 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
8 ICTEAM - Institute of Information and Communication Technologies, Electronics and Applied Mathematics
9 AP-HP - Hopital Saint-Louis [AP-HP]
10 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
11 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
12 Service de Médecine Interne [CHU Clermont-Ferrand]
13 IP - Institut Pascal
14 CHU Saint-Antoine [AP-HP]
15 IMRB - Institut Mondor de Recherche Biomédicale
16 Centre hospitalier de Saint-Nazaire
17 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
18 Hôpital Henri Mondor

Adult'autoimmune hemolytic anemia (AIHA), which is often seen as a rare and "benign" autoimmune hematological disease, can be lifethreatening with an overall mortality rate from 8% to 20% depending on the series 1-3 and a short-term mortality rate that can be up to 30% in intensive care units (ICUs). 4 Factors associated with the need for ICU management of patients with severe AIHA remain partially unknown because only few data are available in the literature. 3-5 The aims of this retrospective observational multicenter study set up by the French reference center for adult immune cytopenias were to: (1) better describe the baseline characteristics and outcome of adults with severe AIHA admitted to an ICU, (2) investigate the factors associated with mortality in the ICU, and (3) identify factors at AIHA diagnosis associated with admission to an ICU. To be included in the study, patients had to (1) be ≥16 years old at the time of AIHA onset; (2) have a diagnosis of AIHA defined as hemoglobin level <12 g/dL, with ≥2 features of hemolysis among low haptoglobin level and/or elevated lactate dehydrogenase (LDH) level and/or elevated free bilirubin level, and a positive direct antiglobulin test (DAT) with no other cause of acquired or hereditary hemolytic anemia; and (3) at least one admission to an ICU specifically for AIHA management between January 2013 and December 2020. We excluded patients with nonautoimmune hemolytic anemia, DAT-negative AIHA and drug-induced immune hemolytic anemia and those admitted to the ICU for another reason than severity of AIHA. Baseline data in the ICU included the Charlson Comorbidity Index, the Knaus score, the Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score

Domaines: Hématologie; Santé publique et épidémiologie

Clara Pouchelon, Charlotte Lafont, Antoine Lafarge, Thibault Comont, Etienne Riviere, et al.. Characteristics and outcome of adults with severe autoimmune hemolytic anemia admitted to the intensive care unit: Results from a large French observational study. 2022, ⟨10.1002/ajh.26665⟩. ⟨hal-04134907⟩