Lee Jongmin, Ban Woo Ho, Kim Sei Won, Kim Eun Young, Han Mi Ra, Kim Seok Chan
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Acute Crit Care. 2020 Feb;35(1):16-23. doi: 10.4266/acc.2019.00675. Epub 2020 Feb 29.
Recent advances in diagnosis and treatment have improved long-term outcomes in cancer patients. As a result, the requirement for a rapid response team (RRT) for cancer patients is also increasing. This study aimed to analyze utilization of an RRT and the associations between related factors and mortality in a population of cancer patients.
This retrospective cohort study included hospitalized patients at a single academic medical center in Seoul, Korea, who required RRT activation during a 6-year period from June 2013 to December 2018.
Overall, 164 of the 457 patients who met the above criteria were cancer patients, and they had a significantly higher Charlson comorbidity score than the non-cancer patients (5.0 vs. 7.0, P<0.001). A significantly larger proportion of cancer patients required intensive care unit transfer (51.8% vs. 41.0%, P=0.032). Cancer patients also had significantly higher in-hospital mortality compared with other patients (39.6% vs. 10.9%, P<0.001). Furthermore, presence of cancer was independently associated with in-hospital mortality (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.11 to 3.93). Among cancer patients, higher Acute Physiology and Chronic Health Evaluation (APACHE) II at the time of RRT activation was significantly associated with in-hospital mortality regardless of malignancy (adjusted OR, 1.08; 95% CI, 1.01 to 1.15).
Cancer patients requiring RRT activation have significantly higher rates of inhospital mortality than patients not using RRT. Higher severity score at the time of RRT activation in patients with malignancy was significantly associated with in-hospital mortality.
诊断和治疗方面的最新进展改善了癌症患者的长期预后。因此，对癌症患者快速反应小组（RRT）的需求也在增加。本研究旨在分析RRT在一组癌症患者中的使用情况以及相关因素与死亡率之间的关联。
这项回顾性队列研究纳入了韩国首尔一家学术医疗中心的住院患者，这些患者在2013年6月至2018年12月的6年期间需要激活RRT。
总体而言，符合上述标准的457例患者中有164例为癌症患者，他们的Charlson合并症评分显著高于非癌症患者（5.0对7.0，P<0.001）。需要转入重症监护病房的癌症患者比例显著更高（51.8%对41.0%，P=0.032）。与其他患者相比，癌症患者的院内死亡率也显著更高（39.6%对10.9%，P<0.001）。此外，癌症的存在与院内死亡率独立相关（调整后的比值比[OR]为2.09；95%置信区间[CI]为1.11至3.93）。在癌症患者中，RRT激活时较高的急性生理与慢性健康状况评估（APACHE）II评分与院内死亡率显著相关，无论恶性肿瘤情况如何（调整后的OR为1.08；95%CI为1.01至1.15）。
需要激活RRT的癌症患者的院内死亡率显著高于未使用RRT的患者。恶性肿瘤患者在RRT激活时较高的严重程度评分与院内死亡率显著相关。
