Department of Haematology, Radboud University Medical Center, Geert Grooteplein 10, P.O. Box 9101, Internal post 492, 6500 HB, Nijmegen, The Netherlands,
Intensive Care Med. 2014 Sep;40(9):1275-84. doi: 10.1007/s00134-014-3373-x. Epub 2014 Jun 28.
To explore trends over time in admission prevalence and (risk-adjusted) mortality of critically ill haematological patients and compare these trends to those of several subgroups of patients admitted to the medical intensive care unit (medical ICU patients).
A total of 1,741 haematological and 60,954 non-haematological patients admitted to the medical ICU were analysed. Trends over time and differences between two subgroups of haematological medical ICU patients and four subgroups of non-haematological medical ICU patients were assessed, as well as the influence of leukocytopenia.
The proportion of haematological patients among all medical ICU patients increased over time [odds ratio (OR) 1.06; 95 % confidence interval (CI) 1.03-1.10 per year; p < 0.001]. Risk-adjusted mortality was significantly higher for haematological patients admitted to the ICU with white blood cell (WBC) counts of <1.0 × 10(9)/L (47 %; 95 % CI 41-54 %) and ≥1.0 × 10(9)/L (45 %; 95 % CI 42-49 %), respectively, than for patients admitted with chronic heart failure (27 %; 95 % CI 26-28 %) and with chronic liver cirrhosis (38 %; 95 % CI 35-42 %), but was not significantly different from patients admitted with solid tumours (40 %; 95 % CI 36-45 %). Over the years, the risk-adjusted hospital mortality rate significantly decreased in both the haematological and non-haematological group with an OR of 0.93 (95 % CI 0.92-0.95) per year. After correction for case-mix using the APACHE-II score (with WBC omitted), a WBC <1.0 × 10(9)/L was not a predictor of mortality in haematological patients (OR 0.86; 95 % CI 0.46-1.64; p = 0.65). We found no case-volume effect on mortality for haematological ICU patients.
An increasing number of haematological patients are being admitted to Dutch ICUs. While mortality is significantly higher in this group of medical ICU patients than in subgroups of non-haematological ones, the former show a similar decrease in raw and risk-adjusted mortality rate over time, while leukocytopenia is not a predictor of mortality. These results suggest that haematological ICU patients have benefitted from improved intensive care support during the last decade.
探讨危重症血液病患者入院率和（风险调整后）死亡率的时间趋势，并与入住内科重症监护病房（内科 ICU）的几个亚组患者的趋势进行比较。
分析了 1741 例血液病和 60954 例非血液病患者。评估了时间趋势以及两组血液病内科 ICU 患者和四组非血液病内科 ICU 患者之间的差异，以及白细胞减少症的影响。
内科 ICU 患者中血液病患者的比例随时间推移而增加[优势比（OR）1.06；95%置信区间（CI）1.03-1.10/年；p<0.001]。白细胞计数<1.0×10^9/L（47%；95%CI 41-54%）和≥1.0×10^9/L（45%；95%CI 42-49%）的 ICU 血液病患者的风险调整死亡率明显高于慢性心力衰竭（27%；95%CI 26-28%）和慢性肝硬化（38%；95%CI 35-42%）患者，但与实体瘤（40%；95%CI 36-45%）患者无显著差异。多年来，血液病和非血液病组的风险调整住院死亡率均显著下降，每年 OR 为 0.93（95%CI 0.92-0.95）。在用急性生理学和慢性健康评估 II 评分（不包括白细胞计数）校正病例组合后，白细胞计数<1.0×10^9/L 不是血液病患者死亡的预测因素（OR 0.86；95%CI 0.46-1.64；p=0.65）。我们未发现血液病 ICU 患者的死亡率存在病例量效应。
越来越多的血液病患者被收治到荷兰的 ICU 中。虽然该组内科 ICU 患者的死亡率明显高于非血液病患者亚组，但前者的死亡率在原始和风险调整方面均呈下降趋势，而白细胞减少症不是死亡率的预测因素。这些结果表明，在过去十年中，血液病 ICU 患者受益于重症监护支持的改善。
