癌症脓毒症患者：院前使用抗生素能否提高生存率？PHANTASi试验的一项亚组分析。

Septic patients with cancer: Do prehospital antibiotics improve survival? A sub-analysis of the PHANTASi trial.

作者信息

Nannan Panday R S, Wang S, Schermer E H, Cooksley T, Alam N, Nanayakkara P W B

机构信息

Section Acute Medicine, Department of Internal Medicine, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

出版信息

Neth J Med. 2020 Feb;78(1):3-9.

PMID:32043473

Abstract

BACKGROUND

Sepsis in patients with cancer is increasingly common and associated with high mortality. To date, no studies have examined the effectiveness of prehospital antibiotics in septic patients with cancer. This study aimed without and to evaluate the effect of prehospital antibiotics in septic patients with cancer.

METHODS

We conducted a post-hoc sub-analysis of the PHANTASi (PreHospital ANTibioitcs Against Sepsis) trial database: a randomised controlled trial which enrolled patients with suspected sepsis who were transported to the emergency department by ambulance. Patients in the intervention group were administered prehospital intravenous antibiotics while those in the control group received usual care. We compared patients who had cancer to those who did not. Primary outcome was 28-day mortality; among the secondary outcomes, we included in-hospital mortality and 90-day mortality.

RESULTS

357(13.4%) of the 2658 included patients had cancer in the past five years, of which, 209 (58.5%) were included in the intervention and 148 (41.5%) usual care groups; 28-day mortality was significantly higher in patients who were diagnosed with cancer in the past five years than those without cancer in the past five years: 15.2% vs. 7.1%, respectively (p < 0.001). Prehospital antibiotics in the group of patients with cancer in the last five years yielded no significant effect on survival. There were however, significantly fewer 30-day readmissions (p = 0.031) in the intervention group of cancer patients (12.2% vs 5.7%).

CONCLUSION

Prehospital antibiotics did not improve overall survival. However, there was a significant reduction in 30-day readmissions.

摘要

背景

癌症患者的脓毒症日益常见，且死亡率很高。迄今为止，尚无研究考察院前抗生素对癌症脓毒症患者的疗效。本研究旨在评估院前抗生素对癌症脓毒症患者的效果。

方法

我们对PHANTASi（院前抗生素治疗脓毒症）试验数据库进行了事后亚组分析：这是一项随机对照试验，纳入了疑似脓毒症且由救护车转运至急诊科的患者。干预组患者接受院前静脉注射抗生素，而对照组患者接受常规治疗。我们比较了有癌症和无癌症的患者。主要结局是28天死亡率；次要结局包括住院死亡率和90天死亡率。

结果

在纳入的2658例患者中，357例（13.4%）在过去五年中有癌症，其中209例（58.5%）纳入干预组，148例（41.5%）纳入常规治疗组；过去五年中被诊断患有癌症的患者的28天死亡率显著高于过去五年中无癌症的患者：分别为15.2%和7.1%（p<0.001）。过去五年中有癌症的患者组中，院前抗生素对生存没有显著影响。然而，癌症患者干预组的30天再入院率显著更低（p=0.031）（12.2%对5.7%）。