Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall J R, Schlemmer B
Medical Intensive Care Unit, Saint Louis Teaching Hospital and University Paris 7, France.
Intensive Care Med. 2000 Dec;26(12):1817-23. doi: 10.1007/s001340051350.
Admission of cancer patients with serious medical complications to the ICU remains controversial primarily because of the high short-term mortality rates in these patients. However, the cancer patient population is heterogeneous regarding age, underlying conditions, and curability of their disease, suggesting that large variations may occur in the effectiveness of intensive care within this subgroup of critically ill patients.
To identify factors predicting 30-day mortality in patients with solid tumors admitted to a medical ICU.
We conducted a retrospective study in 120 consecutive cancer patients (excluding patients with hematological malignancies) admitted to the medical ICU of a 650-bed university hospital between January 1990 and July 1997. Medical history, physical and laboratory test findings at admission, and therapeutic interventions within the first 24 h in the ICU were recorded. The study endpoint was vital status 30 days after ICU admission. Stepwise logistic regression was used to identify independent prognostic factors.
The observed 30-day mortality rate was 58.7 % (n = 68), with most deaths (92 %) occurring in the ICU. Univariate predictors of 30-day mortality were either protective [prior surgery for the cancer (p = 0.01) and complete remission (p = 0.01)] or associated with higher mortality [Knaus scale C or D (p = 0.02), shock (p = 0.04), need for vasopressors (p = 0.0006) or for mechanical ventilation (p = 0.0001), SAPS II score greater than 36 (p = 0.0001), LOD score greater than 6 (p = 0.0001), and ODIN score > 2 (p = 0.0001)]. Three variables were independent predictors: previous surgery for the cancer (OR 0.20, 95 % CI 0.07-0.58), LOD score > 6 (OR 1.26, 95 % CI 1.09-1.44), and need for mechanical ventilation (OR 3.55, 95 % CI; 1.26-6.7). Variables previously thought to be indicative of a poor prognosis (i. e., advanced age, metastatic or progressive disease, neutropenia or bone marrow transplantation) were not predictive of outcome.
When transfer to an ICU is considered an option by patients and physicians, 30-day mortality is better estimated by an evaluation of acute organ dysfunction than by the characteristics of the underlying malignancy.
癌症患者若伴有严重医疗并发症而入住重症监护病房（ICU），仍存在争议，主要原因是这些患者短期死亡率较高。然而，癌症患者群体在年龄、基础疾病以及疾病可治愈性方面存在异质性，这表明在这一危重症患者亚组中，重症监护的有效性可能存在很大差异。
确定入住内科ICU的实体瘤患者30天死亡率的预测因素。
我们对1990年1月至1997年7月期间入住一家拥有650张床位大学医院内科ICU的120例连续癌症患者（不包括血液系统恶性肿瘤患者）进行了一项回顾性研究。记录患者的病史、入院时的体格检查和实验室检查结果，以及入住ICU后最初24小时内的治疗干预措施。研究终点为入住ICU 30天后的生命状态。采用逐步逻辑回归分析确定独立的预后因素。
观察到的30天死亡率为58.7%（n = 68），大多数死亡（92%）发生在ICU内。30天死亡率的单因素预测指标要么具有保护作用[癌症既往手术史（p = 0.01）和完全缓解（p = 0.01）]，要么与较高死亡率相关[克瑙斯量表C或D（p = 0.02）、休克（p = 0.04）、需要血管升压药（p = 0.0006）或机械通气（p = 0.0001）、简化急性生理学评分II（SAPS II）大于36（p = 0.0001）、逻辑器官功能障碍评分（LOD）大于6（p = 0.0001）以及器官功能障碍指数（ODIN）评分> 2（p = 0.0001）]。三个变量为独立预测因素：癌症既往手术史（比值比[OR] 0.20，95%置信区间[CI] 0.07 - 0.58）、LOD评分> 6（OR 1.26, 95% CI 1.09 - 1.44）以及需要机械通气（OR 3.55, 95% CI; 1.26 - 6.7）。先前认为提示预后不良的变量（即高龄、转移性或进展性疾病、中性粒细胞减少或骨髓移植）并不能预测结局。
当患者和医生考虑将患者转入ICU时，通过评估急性器官功能障碍比根据潜在恶性肿瘤的特征能更好地估计30天死亡率。
