Bernal Teresa, Pardavila Estefanía V, Bonastre Juan, Jarque Isidro, Borges Marcio, Bargay Joan, Ayestarán Jose Ignacio, Insausti Josu, Marcos Pilar, González-Sanz Victor, Martínez-Camblor Pablo, Albaiceta Guillermo M
Crit Care. 2013 Dec 30;17(6):R302. doi: 10.1186/cc13172.
Although the survival rates of hematological patients admitted to the ICU are improving, little is known about the long-term outcome. Our objective was to identify factors related to long-term outcome in hematological patients after ICU discharge.
A prospective, observational study was carried out in seven centers in Spain. From an initial sample of 161 hematological patients admitted to one of the participating ICUs during the study period, 62 were discharged alive and followed for a median time of 23 (1 to 54) months. Univariate and multivariate analysis were performed to identify the factors related to long term-survival. Finally, variables that influence the continuation of the scheduled therapy for the hematological disease were studied.
Mortality after ICU discharge was 61%, with a median survival of 18 (1 to 54) months. In the multivariate analysis, an Eastern Cooperative Oncology Group score (ECOG) >2 at ICU discharge (Hazard ratio 11.15 (4.626 to 26.872)), relapse of the hematological disease (Hazard ratio 9.738 (3.804 to 24.93)) and discontinuation of the planned treatment for the hematological disease (Hazard ratio 4.349 (1.286 to 14.705)) were independently related to mortality. Absence of stem cell transplantation, high ECOG and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores decreased the probability of receiving the planned therapy for the hematological malignancy.
Both ICU care and post-ICU management determine the long-term outcome of hematological patients who are discharged alive from the ICU.
尽管入住重症监护病房（ICU）的血液科患者的生存率正在提高，但对于其长期预后却知之甚少。我们的目标是确定血液科患者在ICU出院后的长期预后相关因素。
在西班牙的七个中心进行了一项前瞻性观察研究。在研究期间，从最初入住参与研究的ICU之一的161例血液科患者样本中，62例存活出院，并进行了为期23（1至54）个月的中位随访。进行单因素和多因素分析以确定与长期生存相关的因素。最后，研究了影响血液科疾病预定治疗延续的变量。
ICU出院后的死亡率为61%，中位生存期为18（1至54）个月。在多因素分析中，ICU出院时东部肿瘤协作组（ECOG）评分>2（风险比11.15（4.626至26.872））、血液科疾病复发（风险比9.738（3.804至24.93））以及血液科疾病计划治疗的中断（风险比4.349（1.286至14.705））与死亡率独立相关。未进行干细胞移植、高ECOG评分和高急性生理与慢性健康状况评分系统II（APACHE II）评分降低了接受血液系统恶性肿瘤计划治疗的可能性。
ICU护理和ICU后管理均决定了从ICU存活出院的血液科患者的长期预后。
