Department of Critical Care Medicine, Instituto Nacional de Cancerología, México. Av. San Fernando No. 22, Col. Sección XVI, Delegación Tlalpan, Mexico City, Mexico.
Ann Hematol. 2013 May;92(5):699-705. doi: 10.1007/s00277-013-1675-7. Epub 2013 Jan 18.
The prognosis for patients with hematological malignancies (HMs) admitted to the intensive care unit (ICU) is poor. The objective of this study was to evaluate the clinical characteristics and hospital outcomes of critically ill patients with HMs admitted to an oncological ICU. This is a prospective, observational cohort study. A total of 102 patients with HMs admitted to ICU from January 2008 to April 2011 were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. During the study period, 3,776 patients with HM were admitted to the Department of Hematology of the Instituto Nacional de Cancerología located in Mexico City, Mexico. After being evaluated by the intensivist, 102 (2.68 %) patients were admitted to the ICU. The ICU mortality rates for patients who had two or less organ system failures and for those with three or more organ system dysfunctions were 20 % (5/25) and 70.1 % (54/77), respectively (P < 0.0001). A multivariate analysis identified independent prognostic factors of in-hospital death as neutropenia at the time of ICU admission (odds ratio (OR), 4.24; 95 % confidence interval (CI), 1.36-13.19, P = 0.012), the need for vasopressors (OR, 4.49; 95 % CI, 1.07-18.79, P = 0.040), need for invasive mechanical ventilation (OR, 4.49; 95 % CI, 1.07-18.79, P = 0.040), and serum creatinine >106 μmol/L (OR, 3.21; 95 % CI, 1.05-9.85, P = 0.041). The ICU and hospital mortality rates were 46.1 and 57.8 %, respectively. The independent prognostic factors of in-hospital death were the need for invasive mechanical ventilation, the need for vasopressors, serum creatinine >106 μmol/L, and neutropenia at the time of ICU admission.
入住重症监护病房（ICU）的血液恶性肿瘤（HM）患者的预后较差。本研究旨在评估入住肿瘤 ICU 的重症 HM 患者的临床特征和住院结局。这是一项前瞻性观察性队列研究。共纳入 2008 年 1 月至 2011 年 4 月期间入住 ICU 的 102 例 HM 患者。采用单变量和多变量逻辑回归分析确定与住院死亡率相关的因素。研究期间，墨西哥城国立癌症研究所血液科共收治 3776 例 HM 患者，经重症医师评估后，102 例（2.68%）患者入住 ICU。入住 ICU 时存在 2 个或更少器官系统衰竭和 3 个或更多器官系统功能障碍的患者，其 ICU 死亡率分别为 20%（5/25）和 70.1%（54/77）（P<0.0001）。多变量分析确定院内死亡的独立预后因素为入住 ICU 时中性粒细胞减少症（优势比（OR），4.24；95%置信区间（CI），1.36-13.19，P=0.012）、需要升压药（OR，4.49；95%CI，1.07-18.79，P=0.040）、需要有创机械通气（OR，4.49；95%CI，1.07-18.79，P=0.040）和血清肌酐>106 μmol/L（OR，3.21；95%CI，1.05-9.85，P=0.041）。ICU 和医院死亡率分别为 46.1%和 57.8%。院内死亡的独立预后因素为有创机械通气、需要升压药、血清肌酐>106 μmol/L 和入住 ICU 时中性粒细胞减少症。
