巴西一家医院专门收治血液病患者的重症监护病房中急性白血病患者的死亡率预测因素。

Predictors of mortality among patients with acute leukemias admitted to an intensive care unit specialized in patients with hematological disease at a Brazilian hospital.

作者信息

Corrêa Lorena Costa, Teles Dahra, Silva Odin Barbosa da, Trindade-Filho Gustavo Henriques, Loureiro Paula, Cavalcati Maria do Socorro Mendonça

机构信息

Universidade de Pernambuco (UPE), Recife, PE, Brazil.

Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope), Recife, PE, Brazil.

出版信息

Hematol Transfus Cell Ther. 2020 Jan-Mar;42(1):33-39. doi: 10.1016/j.htct.2019.01.004. Epub 2019 Apr 26.

DOI:10.1016/j.htct.2019.01.004

PMID:31103671

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7031107/

Abstract

INTRODUCTION

Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce.

METHODS

Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009.

RESULTS

In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p<0.001), the increase in the APACHE II score (p<0.038) and having received hemodialysis (p<0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis.

CONCLUSION

With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.

摘要

引言

血液科医生每天都要面对急性白血病患者的高死亡率。很多时候，这些患者需要重症监护病房（ICU）的支持，一些普通ICU团队认为，与其他病症患者相比，这些患者的死亡几率要高得多。在巴西，关于急性白血病患者死亡率和ICU的数据很少。

方法

因此，为了评估入住专业血液科ICU的急性白血病患者的死亡预测因素，我们评估了人口统计学、支持性治疗、住院时间、疾病状态、入院诊断、中性粒细胞减少、输血次数以及急性生理学与慢性健康状况评估（APACHE）/脓毒症相关器官功能衰竭评估（SOFA）评分等可能与死亡率相关的因素。数据取自2006年至2009年间入住伯南布哥血液中心（Hemope）ICU的110例急性白血病患者的首次入院记录。

结果

在这项回顾性队列研究中，110例患者中有72例为男性，64例来自累西腓市区。患者年龄中位数为43.5岁（±17.9）；67.3%患有急性髓系白血病（AML），32.7%患有急性淋巴细胞白血病。ICU的主要入院诊断为脓毒症（66.7%）。APACHE II评分的平均值为18.3。总共有65例（59%）死亡，死亡率与住院时间延长（p<0.001）、APACHE II评分增加（p<0.038）以及接受血液透析（p<0.006）独立相关。中性粒细胞减少、接受多次输血以及入院时使用任何类型的机械通气或血管活性药物与死亡率无关。与较高死亡率相关的因素有：住院时间延长、APACHE II评分增加以及使用血液透析。