Merz Tobias M, Schär Pascale, Bühlmann Michael, Takala Jukka, Rothen Hans U
Department of Intensive Care Medicine, Royal North Shore Hospital of Sydney, University of Sydney, St Leonards, 2065 NSW, Australia.
Crit Care. 2008;12(3):R75. doi: 10.1186/cc6921. Epub 2008 Jun 6.
The paucity of data on resource use in critically ill patients with hematological malignancy and on these patients' perceived poor outcome can lead to uncertainty over the extent to which intensive care treatment is appropriate. The aim of the present study was to assess the amount of intensive care resources needed for, and the effect of treatment of, hemato-oncological patients in the intensive care unit (ICU) in comparison with a nononcological patient population with a similar degree of organ dysfunction.
A retrospective cohort study of 101 ICU admissions of 84 consecutive hemato-oncological patients and 3,808 ICU admissions of 3,478 nononcological patients over a period of 4 years was performed.
As assessed by Therapeutic Intervention Scoring System points, resource use was higher in hemato-oncological patients than in nononcological patients (median (interquartile range), 214 (102 to 642) versus 95 (54 to 224), P < 0.0001). Severity of disease at ICU admission was a less important predictor of ICU resource use than necessity for specific treatment modalities. Hemato-oncological patients and nononcological patients with similar admission Simplified Acute Physiology Score scores had the same ICU mortality. In hemato-oncological patients, improvement of organ function within the first 48 hours of the ICU stay was the best predictor of 28-day survival.
The presence of a hemato-oncological disease per se is associated with higher ICU resource use, but not with increased mortality. If withdrawal of treatment is considered, this decision should not be based on admission parameters but rather on the evolutional changes in organ dysfunctions.
关于血液系统恶性肿瘤重症患者的资源使用数据匮乏，且这些患者预后较差的情况，可能导致对于重症监护治疗适用程度的不确定性。本研究的目的是评估与器官功能障碍程度相似的非肿瘤患者群体相比，重症监护病房（ICU）中血液肿瘤患者所需的重症监护资源量以及治疗效果。
进行了一项回顾性队列研究，纳入了连续84例血液肿瘤患者的101次ICU入院病例以及4年内3478例非肿瘤患者的3808次ICU入院病例。
根据治疗干预评分系统得分评估，血液肿瘤患者的资源使用高于非肿瘤患者（中位数（四分位间距），214（102至642）对95（54至224），P<0.0001）。与特定治疗方式的必要性相比，ICU入院时的疾病严重程度对ICU资源使用的预测作用较小。入院时简化急性生理学评分相似的血液肿瘤患者和非肿瘤患者的ICU死亡率相同。在血液肿瘤患者中，ICU住院前48小时内器官功能的改善是28天生存率的最佳预测指标。
血液肿瘤疾病本身与更高的ICU资源使用相关，但与死亡率增加无关。如果考虑停止治疗，该决定不应基于入院参数，而应基于器官功能障碍的演变变化。
