在综合癌症中心的 ICU 中因急性肾损伤而收治的 IV 期癌症患者中，肾脏替代治疗与生存无关。
Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival.
机构信息
Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Am J Hosp Palliat Care. 2020 Sep;37(9):707-715. doi: 10.1177/1049909120902115. Epub 2020 Jan 27.
INTRODUCTION
In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes.
METHODS
We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission.
RESULTS
Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings.
CONCLUSIONS
Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.
简介
在晚期癌症患者中，治疗延长生命通常会带来巨大的情感和经济负担。在因急性肾损伤（AKI）住院的癌症患者中，已知 AKI 与更高的住院死亡率相关，因此我们调查了重症监护病房（ICU）中使用肾脏替代治疗（RRT）是否是预后更差的独立预测因素。
方法
我们回顾性分析了 2005 年至 2014 年期间被诊断为 IV 期实体瘤、AKI 并接受肾脏科会诊的住院患者。主要结局指标为从里程碑时间点开始的生存时间、住院死亡率和出院后长期生存。使用逻辑回归和 Cox 比例风险回归比较 RRT 和非 RRT 组的住院死亡率和长期生存。使用 2 个选择 ICU 入院后第 2 天和第 7 天的里程碑时间点进行倾向评分匹配的里程碑生存分析。
结果
在因 AKI 入住 ICU 的 465 例 IV 期癌症患者中，有 176 例需要 RRT。在调整基线血清白蛋白和基线最大序贯器官衰竭评估（SOFA）后，多变量逻辑回归模型中，接受 RRT 的患者与未接受 RRT 的患者在住院死亡率方面无显著差异（比值比：1.004 [95%置信区间：0.598-1.684]，P =.9892）。总共对 189 例患者进行了 RRT 对长期生存影响的评估，并得出结论，对于出院时存活的患者，RRT 与出院后的长期生存无显著相关性。第 2 天和第 7 天的里程碑分析证实了相同的发现。
结论
我们的研究发现，对于因 AKI 住院的 IV 期癌症患者，在 ICU 中接受 RRT 与住院死亡率、从里程碑时间点开始的生存时间以及出院后的长期生存无显著相关性。
Zotero 插件