Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Support Care Cancer. 2011 Apr;19(4):491-5. doi: 10.1007/s00520-010-0841-x. Epub 2010 Mar 14.
The decision to start chemotherapy in critically ill cancer patients is extremely complex in the intensive care unit (ICU). Therefore, this study evaluated the outcomes and prognostic factors in critically ill cancer patients receiving chemotherapy in the ICU.
A retrospective analysis was performed using 62 cancer patients who received chemotherapy in the ICU between October 2002 and December 2008. The dataset included 49 hematologic malignancies (79%) and 13 solid tumors (21%).
Twenty (32%) patients were admitted to the ICU with septic shock, 15 (24%) with respiratory failure, and 14 (23%) with renal failure. The median SOFA and SAPS II scores at the time of chemotherapy were 10 (interquartile range, 6-14) and 53 (interquartile range, 41-68), respectively. Twenty-three (37%) patients had concomitant infections when chemotherapy was initiated. Thirty-eight (61%) patients received mechanical ventilation, and 19 (31%) patients underwent renal replacement therapy at the moment of chemotherapy. Overall, 25 (40%) patients died in the ICU; death occurred due to septic shock (13, 52%), cancer progression (9, 36%), or bleeding (2, 8%). ICU mortality after chemotherapy was correlated with respiratory failure requiring mechanical ventilation (OR, 6.26; 95% CI, 1.12-34.95) and a SOFA score of ≥10 (OR, 9.66; 95% CI, 1.43-65.47) upon initiating chemotherapy.
Chemotherapy in the ICU for critically ill cancer patients can be considered even when infection or organ failure is present. However, the severity of organ failure, including respiratory failure requiring mechanical ventilation, was associated with an increased mortality after chemotherapy during an ICU stay.
在重症监护病房（ICU）中，为危重症癌症患者启动化疗的决策极其复杂。因此，本研究评估了在 ICU 中接受化疗的危重症癌症患者的结局和预后因素。
使用 2002 年 10 月至 2008 年 12 月期间在 ICU 接受化疗的 62 例癌症患者进行回顾性分析。数据集包括 49 例血液恶性肿瘤（79%）和 13 例实体瘤（21%）。
20 例（32%）患者因感染性休克、15 例（24%）患者因呼吸衰竭、14 例（23%）患者因肾衰竭而被收入 ICU。化疗时 SOFA 和 SAPS II 评分中位数分别为 10（四分位距，6-14）和 53（四分位距，41-68）。23 例（37%）患者在开始化疗时伴有合并感染。38 例（61%）患者接受机械通气，19 例（31%）患者在化疗时接受肾脏替代治疗。总的来说，25 例（40%）患者在 ICU 中死亡；死亡原因是感染性休克（13 例，52%）、癌症进展（9 例，36%）或出血（2 例，8%）。化疗后 ICU 死亡率与需要机械通气的呼吸衰竭（OR，6.26；95%CI，1.12-34.95）和化疗开始时 SOFA 评分≥10（OR，9.66；95%CI，1.43-65.47）相关。
即使存在感染或器官衰竭，也可以考虑在 ICU 中为危重症癌症患者进行化疗。然而，包括需要机械通气的呼吸衰竭在内的器官衰竭的严重程度与 ICU 住院期间化疗后死亡率的增加相关。
