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计划外收治重症监护病房后存活出院的实体瘤患者的 1 年生存率:一项回顾性研究。

One-year survival in patients with solid tumours discharged alive from the intensive care unit after unplanned admission: A retrospective study.

机构信息

Medical ICU, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.

Biostatistic department, APHP Hopital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.

出版信息

J Crit Care. 2020 Jun;57:36-41. doi: 10.1016/j.jcrc.2020.01.027. Epub 2020 Jan 30.

Abstract

PURPOSE

Outcomes in cancer patients after unplanned ICU admission was reassessed.

METHODS

retrospective cohort of patients with solid tumours admitted to ICU over a 10 years period.

RESULTS

622 patients (age 62 [53-70]) were analysed. The most common primary sites of cancer were lung (n = 133; 21.4%) and digestive tract (n = 126; 20.2%) The ICU mortality rate was 22.2% (n = 138). Among 470 ICU survivors, the 1-year mortality was 41.3% (95% CI, 36-45.9) (n = 167). Factors independently associated with 1-year mortality were ICU admission after 2010 (HR 0.53 (0.37-0.76), p < .001), disease status (respectively, HR = 1.88 (1.0.2-3.45), p = .002) for locally advanced cancer and HR = 2.23 (1.35-3.67), p = .003) for metastatic cancer), poor performance status (HR = 1.58 (1.08-2.31), p = .019), newly diagnosed cancer at ICU admission (HR = 2.02 (1.28-3.20), p = .003), inability to receive oncologic treatment after ICU discharge (HR = 5.34 (3.49-8.18), p < .001) and decision to withhold life-sustaining treatment during ICU stay (HR = 2.34 (1.50-3.65), p < .001).

CONCLUSIONS

Among the factors associated with one-year mortality after ICU discharge, the possibility of receiving oncologic treatment after ICU discharge seems crucial.

摘要

目的

重新评估计划外 ICU 收治的癌症患者的结局。

方法

对 10 年内 ICU 收治的实体瘤患者进行回顾性队列研究。

结果

分析了 622 例患者(年龄 62 [53-70])。最常见的癌症原发部位为肺部(n=133;21.4%)和消化道(n=126;20.2%)。ICU 死亡率为 22.2%(n=138)。在 470 例 ICU 幸存者中,1 年死亡率为 41.3%(95%CI,36-45.9)(n=167)。与 1 年死亡率独立相关的因素包括 2010 年后 ICU 收治(HR 0.53(0.37-0.76),p<.001)、疾病状态(局部晚期癌症 HR=1.88(1.002-3.45),p=0.049)、转移性癌症 HR=2.23(1.35-3.67),p=0.002))、较差的功能状态(HR=1.58(1.08-2.31),p=0.014)、ICU 收治时新诊断的癌症(HR=2.02(1.28-3.20),p=0.003)、ICU 出院后无法接受肿瘤治疗(HR=5.34(3.49-8.18),p<.001)和 ICU 期间决定停止维持生命的治疗(HR=2.34(1.50-3.65),p<.001)。

结论

在与 ICU 出院后 1 年死亡率相关的因素中,ICU 出院后接受肿瘤治疗的可能性似乎至关重要。

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