Medical-Surgical ICU, Paoli-Calmettes Institute, Marseille, France -
Minerva Anestesiol. 2013 Oct;79(10):1156-63. Epub 2013 Jul 15.
Few studies have evaluated outcomes of neutropenic patients admitted to the ICU at the onset of acute respiratory failure (ARF). The main objective of this study was to describe outcomes and to identify early predictors of hospital mortality in critically ill cancer patients with ARF during chemotherapy-induced neutropenia.
Retrospective analysis of prospectively collected data extracted from two recent prospective multicentre studies. We included neutropenic adults admitted to the ICU for ARF.
Of the 123 study patients, 107 patients (87%) had haematological malignancies; 78 (64%) were male, median age was 57 years (44-62), and median LOD score at ICU admission was 6 (4-9). ICU and hospital mortality rates were 42% and 77%, respectively. Endotracheal mechanical ventilation was an independent risk factor for hospital mortality (odds ratio [OR], 7.73; 95% confidence interval [95%CI], 2.52-23.69); two factors independently protected from hospital mortality, namely, ICU admission for ARF during neutropenia recovery (OR, 0.23; 95%CI, 0.07-0.73) and steroid therapy before ICU admission (OR, 0.35; 95%CI, 0.11-0.95).
Our study demonstrates a meaningful ICU survival in the studied population and identified factors associated with ICU and hospital mortality. Further work is needed to address the reasons for the high post-ICU mortality rate after ARF.
鲜有研究评估中性粒细胞减少症患者急性呼吸衰竭（ARF）发作时入住 ICU 的结局。本研究的主要目的是描述结局，并确定接受化疗诱导性中性粒细胞减少症的 ARF 危重症癌症患者的早期死亡预测因素。
回顾性分析从两项近期前瞻性多中心研究中提取的前瞻性收集数据。我们纳入了因 ARF 入住 ICU 的中性粒细胞减少症成人患者。
在 123 例研究患者中，107 例（87%）患有血液系统恶性肿瘤；78 例（64%）为男性，中位年龄为 57 岁（44-62 岁），入住 ICU 时的 LOE 评分中位数为 6 分（4-9 分）。ICU 和医院死亡率分别为 42%和 77%。气管内机械通气是医院死亡率的独立危险因素（比值比[OR]，7.73；95%置信区间[95%CI]，2.52-23.69）；两个因素可独立保护患者避免医院死亡，即中性粒细胞减少症恢复期因 ARF 入住 ICU（OR，0.23；95%CI，0.07-0.73）和入住 ICU 前接受皮质类固醇治疗（OR，0.35；95%CI，0.11-0.95）。
本研究表明，研究人群中 ICU 生存率有显著提高，并确定了与 ICU 和医院死亡率相关的因素。需要进一步研究以解决 ARF 后 ICU 死亡率高的原因。
