Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
Division of Pulmonary, Critical Care, and Sleep Medicine Chang Gung Memorial Hospital, Keelung, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC.
J Formos Med Assoc. 2020 Jan;119(1 Pt 2):276-281. doi: 10.1016/j.jfma.2019.05.012. Epub 2019 May 30.
BACKGROUND/PURPOSE: Patients with cancer are eligible for hospice care when their life expectancy is 180 days or shorter. This study investigated the prognostic factors of patients with cancer and sepsis who were admitted to an intensive care unit (ICU) to assist with clinical decisions of hospice care.
A series of 279 patients admitted to the medical ICU with cancer and sepsis were included. Another series of 109 patients with cancer and sepsis admitted to the other medical ICU in the different branch of our hospital was included to verify the results.
Among 279 patients, the 30-, 90-, and 180-day mortality rates were 47.3%, 72.0%, and 81.0%, respectively. APACHE II score and the cancer control status (controlled or remission (CR), active newly diagnosed (AND) and active recurrent or progressive (ARP)) were significant predictors of 30- and 90-day mortality(30-day: AND(odds ratio: 5.66; 95% confidence interval: 2.12-15.15), ARP(6.24; 2.92-13.33), APACHE II( 1.07; 1.03-1.11); 90-day: AND(4.78; 1.91-11.99), ARP( 24.03; 11.11-51.99), APACHE II( 1.07; 1.02-1.19)) and were associated with a poor 180-day outcome. The 180-day mortality were significantly different among the patients with different cancer control status in the series of 279 patients (CR: 29.8%; AND: 69.4%; and ARP: 98.9 %) and that of 109 patients (46.4%; 96.8%; and 94.0%).
APACHE II score and the cancer control status may be the prognostic factors for critically ill patients with cancer and sepsis, and they may be helpful for evaluating hospice care.
背景/目的：当癌症患者的预期寿命为 180 天或更短时，他们有资格接受临终关怀。本研究旨在探讨入住重症监护病房（ICU）的癌症合并脓毒症患者的预后因素，以协助临床做出临终关怀决策。
纳入了 279 例因癌症合并脓毒症入住我院内科 ICU 的患者。另外纳入了 109 例因癌症合并脓毒症入住我院其他内科 ICU 的患者作为验证队列。
在 279 例患者中，30 天、90 天和 180 天的死亡率分别为 47.3%、72.0%和 81.0%。急性生理与慢性健康状况评分 II（APACHE II）和癌症控制状况（控制或缓解（CR）、新发活动（AND）和复发或进展性活动（ARP））是 30 天和 90 天死亡率的显著预测因素（30 天：AND（比值比：5.66；95%置信区间：2.12-15.15），ARP（6.24；2.92-13.33），APACHE II（1.07；1.03-1.11）；90 天：AND（4.78；1.91-11.99），ARP（24.03；11.11-51.99），APACHE II（1.07；1.02-1.19）），且与 180 天预后不良相关。在 279 例患者中，不同癌症控制状况患者的 180 天死亡率差异有统计学意义（CR：29.8%；AND：69.4%；ARP：98.9%），在 109 例患者中，差异也有统计学意义（CR：46.4%；AND：96.8%；ARP：94.0%）。
APACHE II 评分和癌症控制状况可能是癌症合并脓毒症重症患者的预后因素，有助于评估临终关怀。
