Staudinger T, Stoiser B, Müllner M, Locker G J, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M
Department of Internal Medicine I, University of Vienna, Austria.
Crit Care Med. 2000 May;28(5):1322-8. doi: 10.1097/00003246-200005000-00011.
To assess survival in cancer patients admitted to an intensive care unit (ICU) with respect to the nature of malignancy, cause of ICU admittance, and course during ICU stay as well as to evaluate the prognostic value of the Acute Physiology and Chronic Health Evaluation (APACHE) III score.
Retrospective cohort study.
ICU at a university cancer referral center.
A total of 414 cancer patients admitted to the ICU during a period of 66 months.
None.
Charts of the patients were analyzed with respect to underlying disease, cause of admission, APACHE III score, need and duration of mechanical ventilation, neutropenia and development of septic shock, as well as ICU survival and survival after discharge. Mortality data were compared with two control groups: 1362 patients admitted to our ICU suffering from diseases other than cancer and 2,776 cancer patients not admitted to the ICU.
ICU survival was 53%, and 1-yr survival was 23%. The 1-yr mortality rate was significantly lower in both control groups. Patients admitted after bone marrow transplantation had the highest mortality. In a multivariate analysis, prognosis was negatively influenced by respiratory insufficiency, the need of mechanical ventilation, and development of septic shock during the ICU stay. Admission after cardiopulmonary resuscitation yielded high ICU mortality but a relatively good long-term prognosis. Admission after surgery and as a result of acute hemorrhage was associated with a good prognosis. Age, neutropenia, and underlying disease did not influence outcome significantly. Admission APACHE III scores were significantly higher in nonsurvivors but failed to predict individual outcome satisfactorily. All patients with APACHE III scores of >80 died at the ICU.
A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU. The APACHE III scoring system alone should not be used to make decisions about therapy prolongation. Admission to the ICU worsens the prognosis of a cancer patient substantially; however, as ICU mortality is 47%, comparable with severely ill noncancer patients, general reluctance to admit cancer patients to an ICU does not seem to be justified.
根据恶性肿瘤的性质、入住重症监护病房（ICU）的原因以及在ICU住院期间的病程，评估入住ICU的癌症患者的生存率，并评估急性生理学与慢性健康状况评估（APACHE）III评分的预后价值。
回顾性队列研究。
一所大学癌症转诊中心的ICU。
在66个月期间，共有414例癌症患者入住该ICU。
无。
分析患者病历，内容包括基础疾病、入院原因、APACHE III评分、机械通气的需求及持续时间、中性粒细胞减少症和感染性休克的发生情况，以及ICU生存率和出院后的生存率。将死亡率数据与两个对照组进行比较：1362例入住我们ICU的非癌症疾病患者和2776例未入住ICU的癌症患者。
ICU生存率为53%，1年生存率为23%。两个对照组的1年死亡率均显著较低。骨髓移植后入院的患者死亡率最高。在多变量分析中，呼吸功能不全、机械通气需求以及在ICU住院期间发生感染性休克对预后有负面影响。心肺复苏后入院的患者ICU死亡率较高，但长期预后相对较好。手术后因急性出血入院的患者预后良好。年龄、中性粒细胞减少症和基础疾病对结局无显著影响。非幸存者的入院APACHE III评分显著更高，但未能令人满意地预测个体结局。所有APACHE III评分>80的患者均在ICU死亡。
必须综合考虑多种因素来评估重症癌症患者在ICU的预后。不应仅使用APACHE III评分系统来决定是否延长治疗。入住ICU会显著恶化癌症患者的预后；然而，由于ICU死亡率为47%，与重症非癌症患者相当，一般不愿将癌症患者收入ICU似乎没有道理。
