Khwankeaw Jirateep, Bhurayanontachai Rungsun
J Med Assoc Thai. 2014 Jan;97 Suppl 1:S77-83.
Recent treatments in hematological malignancies have substantially improved. Unfortunately, once a patient with a hematological malignancy has complications, the prognosis is poor and the in hospital and ICU mortality rates are high. Debates concerning the reluctance to admit patients into ICUs with poor prognoses often emerge. The aim of the present study is to identify the patients who are more likely to benefit from ICU admissions.
To assess the outcomes and to identify early mortality risk factors in patients with lymphoma and acute myeloid leukemia admitted to the Intensive Care Unit (ICU) at Songklanagarind Hospital in the south of Thailand.
This is a retrospective study of patients diagnosed with lymphoma and acute myeloid leukemia admitted to the ICU during the period of January 2004 through May 2008. Demographic factors, acute physiology, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and variables noted in the first 24-hours were collected. The risk factors for deaths in the ICU were studied by univariate and multivariate analysis. The risk factors taken from the best multivariate analysis model were calculated to predict the probability of lCU mortality.
A total of 145 patients were studied. The ICU mortality rate was 55.2%. The major cause of death was septic shock. Using univariate analysis, the significant mortality risk factors were neutropenia, mechanical ventilation, the use of vasopressors, abnormal serum creatinine (Cr) and APACHE II scores (p < 0.05). Using multivariate analysis, ICU mortality was best predicted on admission by mechanical ventilation, the use of vasopressors and the APACHE II scores. The presence of neutropenia, mechanical ventilation, vasopressors and an APACHE II score of greater than 27 predicts 80% sensitivity and a 75% specificity for an 82% ICU mortality.
Patients with lymphoma and acute myeloid leukemia admitted into the ICU referral center in the south of Thailand who had mechanical ventilation, use of vasopressors and APACHE II scores greater than 27 were associated with a higher ICU mortality rate. The authors suggest that early identification of the subgroup of patients whose probability of survival is so low that advanced ICU support should not be continued would be a more reasonable goal. This will allow more efficient care to potential survivors not in this group.
血液系统恶性肿瘤的近期治疗有了显著改善。不幸的是，一旦血液系统恶性肿瘤患者出现并发症，预后就很差，住院和重症监护病房（ICU）死亡率都很高。关于不愿收治预后不良患者进入ICU的争论经常出现。本研究的目的是确定更有可能从入住ICU中获益的患者。
评估泰国南部宋卡纳卡林医院重症监护病房（ICU）收治的淋巴瘤和急性髓系白血病患者的预后，并确定早期死亡风险因素。
这是一项对2004年1月至2008年5月期间入住ICU的淋巴瘤和急性髓系白血病患者的回顾性研究。收集了人口统计学因素、急性生理学、急性生理学与慢性健康状况评估（APACHE）II评分以及最初24小时内记录的变量。通过单因素和多因素分析研究ICU死亡的风险因素。根据最佳多因素分析模型得出的风险因素计算预测ICU死亡率的概率。
共研究了145例患者。ICU死亡率为55.2%。主要死亡原因是感染性休克。单因素分析显示，显著的死亡风险因素是中性粒细胞减少、机械通气、使用血管升压药、血清肌酐（Cr）异常和APACHE II评分（p<0.05）。多因素分析显示，入院时ICU死亡率的最佳预测因素是机械通气、使用血管升压药和APACHE II评分。存在中性粒细胞减少、机械通气、血管升压药以及APACHE II评分大于27对ICU死亡率为82%的预测敏感性为80%，特异性为75%。
入住泰国南部ICU转诊中心的淋巴瘤和急性髓系白血病患者，若进行机械通气、使用血管升压药且APACHE II评分大于27，则ICU死亡率较高。作者认为，早期识别生存概率极低以至于不应继续进行高级ICU支持的患者亚组将是一个更合理的目标。这将使对不在该组的潜在幸存者能够提供更有效的治疗。
