Al-Zubaidi Nassar, Shehada Emad, Alshabani Khaled, ZazaDitYafawi Jihane, Kingah Pascal, Soubani Ayman O
Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, United States.
Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, United States.
Hematol Oncol Stem Cell Ther. 2018 Dec;11(4):206-218. doi: 10.1016/j.hemonc.2018.03.003. Epub 2018 Apr 17.
Several studies showed conflicting results about prognosis and predictors of outcome of critically ill patients with hematological malignancies (HM). The aim of this study is to determine the hospital outcome of critically ill patients with HM and the factors predicting the outcome.
All patients with HM admitted to MICU at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and 6 months outcomes were documented.
There were 130 HM patients during the study period. Acute Leukemia was the most common malignancy (31.5%) followed by Non-Hodgkin's Lymphoma (28.5%). About 12.5% patients had autologous HSCT and 51.5% had allogeneic HSCT. Sepsis was the most common ICU diagnosis (25.9%). ICU mortality and hospital mortality were 24.8% and 45.3%, respectively. Six months mortality (available on 80% of patients) was 56.7%. Hospital mortality was higher among mechanically ventilated patients (75%). Using multivariate analysis, only mechanical ventilation (OR of 19.0, CI: 3.1-117.4, P: 0.001) and allogeneic HSCT (OR of 10.9, CI: 1.8-66.9, P: 0.01) predicted hospital mortality.
Overall hospital outcome of critically ill patients with HM is improving. However those who require mechanical ventilation or underwent allogeneic HSCT continue to have poor outcome.
多项研究显示，关于血液系统恶性肿瘤（HM）危重症患者的预后及预后预测因素，结果相互矛盾。本研究旨在确定HM危重症患者的院内结局及预测结局的因素。
纳入一家三级学术医疗中心重症监护病房（MICU）收治的所有HM患者。收集入院时及在ICU住院期间的临床资料。记录住院、ICU及6个月时的结局。
研究期间共有130例HM患者。急性白血病是最常见的恶性肿瘤（31.5%），其次是非霍奇金淋巴瘤（28.5%）。约12.5%的患者接受了自体造血干细胞移植（HSCT），51.5%的患者接受了异基因HSCT。脓毒症是最常见的ICU诊断（25.9%）。ICU死亡率和医院死亡率分别为24.8%和45.3%。6个月死亡率（80%的患者可获得该数据）为56.7%。机械通气患者的医院死亡率更高（75%）。多因素分析显示，仅机械通气（比值比[OR]为19.0，可信区间[CI]：3.1 - 117.4，P：0.001）和异基因HSCT（OR为10.9，CI：1.8 - 66.9，P：0.01）可预测医院死亡率。
HM危重症患者的总体院内结局正在改善。然而，需要机械通气或接受异基因HSCT的患者结局仍然较差。
