Kingah Pascal, Alzubaidi Nasser, Yafawi Jihane Zaza Dit, Shehada Emad, Alshabani Khaled, Soubani Ayman O
Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, Detroit MI 48201, USA.
J Crit Care Med (Targu Mures). 2018 Oct 1;4(4):137-142. doi: 10.2478/jccm-2018-0019. eCollection 2018 Oct.
Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes.
All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented.
There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 - 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races.
This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.
多项研究在实体恶性肿瘤危重症患者的预后及预后预测因素方面呈现出相互矛盾的结果。本研究旨在确定入住医院的实体恶性肿瘤危重症患者的预后以及与预后相关的因素。
纳入所有在一所三级学术医疗中心的重症监护病房（ICU）住院的实体恶性肿瘤患者。收集入院时及ICU住院期间的临床数据。记录医院、ICU及六个月的预后情况。
研究期间有252例实体恶性肿瘤患者。泌尿生殖系统恶性肿瘤最为常见（26.3%），其次是肺癌（23.5%）。急性呼吸衰竭是最常见的ICU诊断（51.6%），其次是脓毒症，占46%。ICU死亡率和医院死亡率分别为21.8%和34.3%。六个月死亡率为38.4%。多因素分析显示，急性肾损伤，比值比（OR）2.82，95%可信区间（CI）1.50 - 5.32，P = 0.001；机械通气的使用，OR 2.67，95%CI 1.37 - 5.19，P = 0.004；以及体能状态≥2，OR为3.05，95%CI为1.5 - 6.2，P = 0.002与医院死亡率相关。非裔美国患者（占所有患者的53%）与其他种族在预后方面无差异。
本研究报告了入住ICU的实体恶性肿瘤患者令人鼓舞的生存率。基线体能状态差、需要机械通气或发生急性肾衰竭的患者预后较差。
