Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
Crit Care. 2019 Aug 27;23(1):286. doi: 10.1186/s13054-019-2568-5.
Patients with hematologic malignancies who are admitted to hospital are at increased risk of deterioration and death. Rapid response systems (RRSs) respond to hospitalized patients who clinically deteriorate. We sought to describe the characteristics and outcomes of hematologic oncology inpatients requiring rapid response system (RRS) activation, and to determine the prognostic accuracy of the SIRS and qSOFA criteria for in-hospital mortality of hematologic oncology patients with suspected infection.
We used registry data from two hospitals within The Ottawa Hospital network, between 2012 and 2016. Consecutive hematologic oncology inpatients who experienced activation of the RRS were included in the study. Data was gathered at the time of RRS activation and assessment. The primary outcome was in-hospital mortality. Logistical regression was used to evaluate for predictors of in-hospital mortality.
We included 401 patients during the study period. In-hospital mortality for all included patients was 41.9% (168 patients), and 145 patients (45%) were admitted to ICU following RRS activation. Among patients with suspected infection at the time of RRS activation, Systemic Inflammatory Response Syndrome (SIRS) criteria had a sensitivity of 86.9% (95% CI 80.9-91.6) and a specificity of 38.2% (95% CI 31.9-44.8) for predicting in-hospital mortality, while Quick Sequential Organ Failure Assessment (qSOFA) criteria had a sensitivity of 61.9% (95% CI 54.1-69.3) and a specificity of 91.4% (95% CI 87.1-94.7). Factors associated with increased in-hospital mortality included transfer to ICU after RRS activation (adjusted odds ratio [OR] 3.56, 95% CI 2.12-5.97) and a higher number of RRS activations (OR 2.45, 95% CI 1.63-3.69). Factors associated with improved survival included active malignancy treatment at the time of RRS activation (OR 0.54, 95% CI 0.34-0.86) and longer hospital length of stay (OR 0.78, 95% CI 0.70-0.87).
Hematologic oncology inpatients requiring RRS activation have high rates of subsequent ICU admission and mortality. ICU admission and higher number of RRS activations are associated with increased risk of death, while active cancer treatment and longer hospital stay are associated with lower risk of mortality. Clinicians should consider these factors in risk-stratifying these patients during RRS assessment.
因血液系统恶性肿瘤住院的患者有病情恶化和死亡的风险增加。快速反应系统（RRS）用于应对临床恶化的住院患者。我们旨在描述需要快速反应系统（RRS）激活的血液肿瘤住院患者的特征和结局，并确定全身炎症反应综合征（SIRS）和快速序贯器官衰竭评估（qSOFA）标准对疑似感染的血液肿瘤患者院内死亡率的预测准确性。
我们使用了 2012 年至 2016 年期间来自渥太华医院网络内两家医院的登记数据。纳入经历 RRS 激活的连续血液肿瘤住院患者。数据在 RRS 激活和评估时收集。主要结局是院内死亡率。逻辑回归用于评估院内死亡率的预测因素。
研究期间纳入了 401 名患者。所有纳入患者的院内死亡率为 41.9%（168 例），有 145 例（45%）患者在 RRS 激活后被转入 ICU。在 RRS 激活时怀疑感染的患者中，SIRS 标准预测院内死亡率的敏感性为 86.9%（95%CI 80.9-91.6），特异性为 38.2%（95%CI 31.9-44.8），而 qSOFA 标准的敏感性为 61.9%（95%CI 54.1-69.3），特异性为 91.4%（95%CI 87.1-94.7）。与院内死亡率增加相关的因素包括 RRS 激活后转入 ICU（调整后的优势比[OR]3.56，95%CI 2.12-5.97）和 RRS 激活次数增加（OR 2.45，95%CI 1.63-3.69）。与生存改善相关的因素包括 RRS 激活时进行的积极恶性肿瘤治疗（OR 0.54，95%CI 0.34-0.86）和住院时间延长（OR 0.78，95%CI 0.70-0.87）。
需要 RRS 激活的血液肿瘤住院患者 ICU 入院率和死亡率均较高。ICU 入院和 RRS 激活次数增加与死亡风险增加相关，而积极的癌症治疗和住院时间延长与死亡率降低相关。临床医生在 RRS 评估时应考虑这些因素对这些患者进行风险分层。
