Cornet Alexander D, Issa Aart I, van de Loosdrecht Arjan A, Ossenkoppele Gert J, Strack van Schijndel Rob J M, Groeneveld A B Johan
Department of Intensive Care, Institute for Cardiovascular Research, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands.
Eur J Haematol. 2005 Jun;74(6):511-6. doi: 10.1111/j.1600-0609.2005.00418.x.
Poor survival of patients with a haematological malignancy admitted to the intensive care unit (ICU) prompts for proper admission triage and prediction of ICU treatment failure and long-term mortality. We therefore tried to find predictors of the latter outcomes.
A retrospective analysis of charts and a prospective follow-up study were done, of haemato-oncological patients, admitted to our ICU in a 7-year period with a follow-up until 2 yr thereafter. Clinical parameters during the first four consecutive days were taken to calculate the simplified acute physiology (SAPS II) and the sequential organ failure assessment (SOFA) scores, of proven predictive value in general ICU populations.
From a total of 58 patients (n = 47 with acute myelogenous leukaemia or non-Hodgkin lymphoma), admitted into ICU mostly because of respiratory insufficiency, sepsis, shock or combinations, 36 patients had died during their stay in the ICU. Of ICU survivors (n = 22), 20 patients died during follow-up so that the 1-year survival rate was only 12%. The SAPS II and particularly the SOFA scores were of high predictive value for ICU and long-term mortality.
Patients with life-threatening complications of haematological malignancy admitted to ICU ran a high risk for death in the ICU and on the long-term, and the risk can be well predicted by SOFA. The latter may help us to decide on intensive care in individual cases, in order to avoid potentially futile care for patients with a SOFA score of 15 or higher.
入住重症监护病房（ICU）的血液系统恶性肿瘤患者生存率较低，这促使我们进行适当的入院分诊，并预测ICU治疗失败和长期死亡率。因此，我们试图找出这些预后的预测因素。
对血液肿瘤患者的病历进行回顾性分析，并进行前瞻性随访研究，这些患者在7年期间入住我们的ICU，并在此后进行了2年的随访。选取连续4天的临床参数来计算简化急性生理学评分（SAPS II）和序贯器官衰竭评估（SOFA）评分，这两个评分在一般ICU患者群体中已被证实具有预测价值。
共有58例患者（n = 47例急性髓系白血病或非霍奇金淋巴瘤患者）入住ICU，主要原因是呼吸功能不全、败血症、休克或多种情况并存，其中36例患者在ICU住院期间死亡。在ICU幸存者（n = 22例）中，20例患者在随访期间死亡，因此1年生存率仅为12%。SAPS II评分，尤其是SOFA评分对ICU死亡率和长期死亡率具有较高的预测价值。
入住ICU的血液系统恶性肿瘤患者出现危及生命的并发症时，在ICU及长期均面临较高的死亡风险，SOFA评分可以很好地预测这种风险。后者可能有助于我们在个别病例中决定是否进行重症监护，以避免对SOFA评分为15分或更高的患者进行可能无效的治疗。
