Lemiale Virginie, Pons Stéphanie, Mirouse Adrien, Tudesq Jean-Jacques, Hourmant Yannick, Mokart Djamel, Pène Frédéric, Kouatchet Achille, Mayaux Julien, Nyunga Martine, Bruneel Fabrice, Meert Anne-Pascale, Borcoman Edith, Bisbal Magali, Legrand Matthieu, Benoit Dominique, Azoulay Elie, Darmon Michaël, Zafrani Lara
Medical ICU, Saint-Louis Teaching Hospital, Paris, France.
U976, INSERM, Paris, France.
Crit Care Med. 2020 Jun;48(6):822-829. doi: 10.1097/CCM.0000000000004322.
Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades.
Seven European ICUs.
A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality.
Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015).
Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not.
Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.
癌症影响多达20%的重症患者，脓毒症是这类患者入住重症监护病房（ICU）的主要原因之一。早期迹象表明该人群的生存率可能在上升。然而，缺乏相关的验证研究。本研究的目的是评估过去20年因脓毒症或脓毒性休克入住ICU的癌症患者的生存率随时间的变化趋势。
七个欧洲ICU。
采用一个将入院年份和源数据集作为随机变量的分层模型来确定第30天死亡率的风险因素。
从肿瘤血液学复苏呼吸研究组数据库（1994 - 2015年）中提取因脓毒症或脓毒性休克入住ICU的癌症患者的数据。
总体而言，2062例患者（62%为男性，年龄中位数[四分位间距]为59岁[48 - 67岁]）纳入研究。潜在恶性肿瘤为实体瘤（n = 362；17.6%）或血液系统恶性肿瘤（n = 1700；82.4%），包括急性白血病（n = 591；28.7%）、非霍奇金淋巴瘤（n = 461；22.3%）和骨髓瘤（n = 244；11.8%）。250例患者（12%）接受了异基因造血干细胞移植，640例（31.0%）在入住ICU时为中性粒细胞减少。第30天死亡率为39.9%（823例死亡）。ICU入院年份与第30天死亡率随时间显著降低相关（比值比，0.96；95%置信区间，0.93 - 0.98；p = 0.001）。机械通气（比值比，3.25；95%置信区间，2.52 - 4.19；p < 0.01）和血管升压药的使用（比值比，1.42；95%置信区间，1.10 - 1.83；p < 0.01）与第30天死亡率独立相关，而潜在恶性肿瘤、异基因造血干细胞移植和中性粒细胞减少则无关。
重症肿瘤和血液学脓毒症患者的生存率随时间显著提高。随着预后改善，临床医生应考虑更新该人群的入院政策和治疗目标。
