Cherif Honar, Martling Claes-Roland, Hansen Jan, Kalin Mats, Björkholm Magnus
Division of Haematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Support Care Cancer. 2007 Dec;15(12):1393-8. doi: 10.1007/s00520-007-0268-1. Epub 2007 May 22.
The admission of patients with hematological disorders to the intensive care unit (ICU) involves a complex resource usage and may be associated with high mortality. The decision making to transfer a severely ill patient to the ICU, therefore, presents an ethical dilemma. We assessed both early and long-term outcomes in relation to clinical characteristics with the aim to facilitate clinical decision making.
We performed a cohort study of hematological patients admitted to ICU at a university hospital.
During a 6-year period (1996-2001), 85 patients with a median age of 59 years were admitted to ICU. The majority of patients (88%) suffered from hematological malignancies. Major reasons for ICU admission were respiratory failure (41%) and septic shock/pre-shock (24%). The median duration of ICU admission was 2 (1-67) days. Crude in-ICU, 30-day, and 6-month mortality rates were 30, 49, and 62%, respectively. Overall 5-year survival rate was 20%, and 13 (15%) patients were alive at time of follow-up (median 7.4 years). Respiratory failure requiring ventilatory support and a high Acute Physiology and Chronic Health Evaluation II score was significantly correlated to high in-ICU mortality, but not to long-term outcome. Type of hematological malignancy, neutropenia, thrombocytopenia, bacteremia, prior administration of chemotherapy, age, or gender was not significantly associated with outcome.
The current study provides encouraging results on long-term post-ICU outcome also in elderly patients with hematological diseases. For a substantial proportion of critically ill hematological patients, a short time care at an ICU is lifesaving. These patients should be offered intensive care unless or until it is clear that there is little prospect of recovery from the acute illness or that the underlying malignancy cannot be controlled.
血液系统疾病患者入住重症监护病房（ICU）涉及复杂的资源利用，且可能与高死亡率相关。因此，将重症患者转入ICU的决策面临伦理困境。我们评估了与临床特征相关的早期和长期结局，旨在促进临床决策。
我们对一所大学医院收治入ICU的血液系统疾病患者进行了队列研究。
在6年期间（1996 - 2001年），85例中位年龄为59岁的患者入住了ICU。大多数患者（88%）患有血液系统恶性肿瘤。入住ICU的主要原因是呼吸衰竭（41%）和感染性休克/休克前期（24%）。ICU住院时间的中位数为2（1 - 67）天。ICU内的粗死亡率、30天死亡率和6个月死亡率分别为30%、49%和62%。总体5年生存率为20%，13例（15%）患者在随访时存活（中位随访时间7.4年）。需要通气支持的呼吸衰竭以及高急性生理与慢性健康状况评分II与ICU内高死亡率显著相关，但与长期结局无关。血液系统恶性肿瘤的类型、中性粒细胞减少、血小板减少、菌血症、先前是否接受化疗、年龄或性别与结局均无显著关联。
本研究为老年血液系统疾病患者ICU后的长期结局提供了令人鼓舞的结果。对于相当一部分重症血液系统疾病患者，在ICU进行短期治疗可挽救生命。除非或直到明确急性疾病恢复的希望渺茫或潜在恶性肿瘤无法控制，否则应给予这些患者重症监护。
