Medical intensive care unit, Cochin hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Hematology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Crit Care Med. 2018 May;46(5):e465-e468. doi: 10.1097/CCM.0000000000002990.
Hematologic malignancies may result in multiple organ involvement including pulmonary and renal dysfunctions, and the less common acute circulatory failure. We herein addressed the outcome of patients with sepsis-like shock related to aggressive hematologic malignancies.
A 10-year (2007-2016) monocenter retrospective study.
A medical ICU in a tertiary care center.
Patients with circulatory shock requiring vasopressors and who subsequently received chemotherapy. Shock was presumably related to the underlying malignancy after ruling out an ongoing or new-onset infectious process. The extent and time course of organ failures was assessed by a modified Sequential Organ Failure Assessment score devoid of the platelet component.
None.
Seventeen patients were included, including 13 with non-Hodgkin lymphoma, two with hyperleukocytic acute myeloid leukemia, and two with "Human Herpes virus 8"-associated multicentric Castleman's disease. The following associated conditions prompted urgent administration of chemotherapy: tumor lysis syndrome (n = 10), hemophagocytic lymphohistiocytosis (n = 3), compressive bulky tumor (n = 3), pulmonary involvement (n = 3), and disseminated intravascular coagulation (n = 1). Following the initiation of chemotherapy, a number of patients died rapidly from untractable multiple organ failure. In contrast, chemotherapy led to a fast and dramatic improvement in organ failures in early survivors, as shown by the decrease in the modified Sequential Organ Failure Assessment score. However, the overall outcome was poor since only four and three patients could be discharged alive from the ICU and the hospital, and three and two patients remained alive at 6 months and 1 year.
Multiple organ dysfunction syndrome related to hematologic malignancies is associated with a dismal outcome. A chemotherapy trial may provide a fast prognostic assessment of the reversibility of organ failure.
血液系统恶性肿瘤可能导致多个器官受累，包括肺部和肾脏功能障碍，以及较少见的急性循环衰竭。本研究旨在探讨与侵袭性血液系统恶性肿瘤相关的类败血症性休克患者的结局。
一项 10 年（2007-2016 年）单中心回顾性研究。
一家三级护理中心的医疗重症监护病房。
需要升压药物治疗且随后接受化疗的循环休克患者。在排除持续或新发感染过程后，假设休克与潜在恶性肿瘤有关。通过不包含血小板成分的改良序贯器官衰竭评估评分评估器官衰竭的程度和时间进程。
无。
共纳入 17 例患者，包括 13 例非霍奇金淋巴瘤、2 例高白细胞性急性髓细胞白血病和 2 例“人类疱疹病毒 8”相关的多中心卡斯特曼病。以下相关情况促使紧急给予化疗：肿瘤溶解综合征（n=10）、噬血细胞性淋巴组织细胞增多症（n=3）、压迫性大块肿瘤（n=3）、肺部受累（n=3）和弥漫性血管内凝血（n=1）。化疗开始后，许多患者因难以控制的多器官衰竭迅速死亡。相比之下，在早期幸存者中，化疗迅速显著改善了器官衰竭，表现为改良序贯器官衰竭评估评分的降低。然而，整体预后较差，因为只有 4 例和 3 例患者能够从 ICU 和医院存活出院，3 例和 2 例患者在 6 个月和 1 年内仍然存活。
与血液系统恶性肿瘤相关的多器官功能障碍综合征与不良结局相关。化疗试验可能提供对器官衰竭可逆性的快速预后评估。
