Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Republic of Korea.
J Crit Care. 2011 Feb;26(1):107.e1-6. doi: 10.1016/j.jcrc.2010.07.006. Epub 2010 Sep 1.
In critically ill patients with hematologic malignancies, acute kidney injury (AKI) usually occurs in the context of multiple organ failure due to various etiologies and is associated with poor prognosis. The objective of the present study was to identify the prognostic factors associated with intensive care unit (ICU) mortality in patients with hematologic malignancies and AKI requiring renal replacement therapy (RRT).
We retrospectively evaluated 94 patients with hematologic malignancies and AKI who received RRT in the ICU of Samsung Medical Center, Seoul, Korea, between January 2004 and December 2007.
The study sample included 65 men and 29 women with a median age of 49 years (interquartile range [IQR], 36-61 years). The median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment (SOFA) scores at ICU admission were 64 (IQR, 46-79) and 13 (IQR, 9-16), respectively. The RRT for AKI was initiated at a median time of 1 day (IQR, 0-4 day) after ICU admission. Seventy-two (77%) patients died in the ICU after a median time of 4 days (IQR, 2-20 days) after the initiation of RRT. Among the 22 patients who survived, 5 (23%) required RRT after ICU discharge. Intensive care unit mortality was associated with an etiology of AKI, Simplified Acute Physiology Score II score, and SOFA score. Modified SOFA (mSOFA) score (defined as the sum of the 5 nonrenal components of the SOFA score) at the initiation of RRT was lower in survivors than in nonsurvivors. In a multiple logistic regression analysis, ICU mortality was independently associated with mSOFA score (odds ratio, 1.83 per mSOFA score increase; 95% confidence interval, 1.38-2.42) at the initiation of RRT. The estimated area under the curve for mSOFA score was 0.902 (95% confidence interval, 0.831-0.972).
The severity of organ failure, excluding renal failure, at initiation of RRT was independently associated with ICU mortality in patients with hematologic malignancies and AKI requiring RRT.
在患有血液恶性肿瘤的危重症患者中，急性肾损伤（AKI）通常由于多种病因导致多器官衰竭而发生，并与预后不良相关。本研究的目的是确定需要肾脏替代治疗（RRT）的血液恶性肿瘤合并 AKI 患者发生重症监护病房（ICU）死亡的相关预后因素。
我们回顾性评估了 2004 年 1 月至 2007 年 12 月期间在韩国首尔三星医疗中心 ICU 接受 RRT 的 94 例血液恶性肿瘤合并 AKI 患者。
研究样本包括 65 名男性和 29 名女性，中位年龄为 49 岁（四分位间距[IQR]，36-61 岁）。入住 ICU 时的简化急性生理学评分 II （SAPS II）和序贯器官衰竭评估（SOFA）中位数分别为 64（IQR，46-79）和 13（IQR，9-16）。AKI 的 RRT 中位启动时间为入住 ICU 后 1 天（IQR，0-4 天）。RRT 启动后中位 4 天（IQR，2-20 天）后，72（77%）例患者在 ICU 死亡。在 22 例存活患者中，有 5 例（23%）在 ICU 出院后需要 RRT。ICU 死亡率与 AKI 的病因、SAPS II 评分和 SOFA 评分相关。与存活者相比，RRT 启动时的改良 SOFA（mSOFA）评分（定义为 SOFA 评分中 5 个非肾脏成分的总和）较低。在多因素逻辑回归分析中，RRT 启动时 mSOFA 评分与 ICU 死亡率独立相关（优势比，mSOFA 评分每增加 1 分，1.83；95%置信区间，1.38-2.42）。mSOFA 评分的曲线下面积估计值为 0.902（95%置信区间，0.831-0.972）。
需要 RRT 的血液恶性肿瘤合并 AKI 患者，RRT 启动时除肾衰竭以外的器官衰竭严重程度与 ICU 死亡率独立相关。
