Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung.
Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung.
Cancer Control. 2020 Jul-Aug;27(3):1073274820920733. doi: 10.1177/1073274820920733.
A positive fluid balance has been found to be deleterious in critically ill patients; however, the impact of early fluid balance, particularly on long-term outcomes, in critically ill patients with cancer remains unclear. We performed this retrospective study at a tertiary-care referral hospital with 1500 beds and 6 intensive care units (ICUs) in central Taiwan, and 942 patients with cancer admitted to ICUs during 2013 to 2016 were enrolled. The primary outcome was 1-year mortality. Cancer-related data were obtained from the cancer registry, and data during ICU admissions were retrieved from the electronic medical records. The association between fluid balance, which was represented by median and interquartile range, and 1-year mortality was determined by calculating the hazard ratio (HR) with 95% confidence interval (CI) using a multivariable Cox proportional hazards regression model. The in-hospital mortality rate was 22.9% (216 of 942), and the mortality within 1 year after the index ICU admission was 38.7% (365 of 942). Compared to survivors, nonsurvivors tended to have a higher Acute Physiology and Chronic Health Evaluation II score (24.1 ± 6.9 vs 20.5 ± 6.2, < .01), a higher age (65.0 ± 14.4 vs 61.3 ± 14.3, < .01), a higher serum creatinine (1.5 ± 1.3 vs 1.0 ± 1.0, < .01), and a higher cumulative day 1 to 4 fluid balance (2669, 955-5005 vs 4103, 1268-7215 mL, < .01). Multivariable Cox proportional hazards regression analysis found that cumulative day-4 fluid balance was independently associated with 1-year mortality (adj HR 1.227, 95% CI: 1.132-1.329). A positive day 1 to 4 cumulative fluid balance was associated with shorter 1-year survival in critically ill patients with cancer. Further studies are needed to validate this association.
液体正平衡与危重症患者的不良预后相关；然而，癌症危重症患者早期液体平衡，尤其是对长期预后的影响仍不明确。我们在台湾中部一家拥有 1500 张床位和 6 个重症监护病房（ICU）的三级转诊医院进行了这项回顾性研究，纳入了 2013 年至 2016 年期间入住 ICU 的 942 例癌症患者。主要结局为 1 年死亡率。癌症相关数据来自癌症登记处，而 ICU 入住期间的数据则从电子病历中获取。通过使用多变量 Cox 比例风险回归模型计算风险比（HR）及其 95%置信区间（CI），来确定以中位数和四分位距表示的液体平衡与 1 年死亡率之间的关联。医院死亡率为 22.9%（942 例中的 216 例），指数 ICU 入院后 1 年内死亡率为 38.7%（942 例中的 365 例）。与幸存者相比，非幸存者的急性生理学和慢性健康评估 II 评分更高（24.1±6.9 比 20.5±6.2， <.01），年龄更大（65.0±14.4 比 61.3±14.3， <.01），血清肌酐更高（1.5±1.3 比 1.0±1.0， <.01），第 1 至 4 天累积液体平衡量更高（2669，955-5005 比 4103，1268-7215 毫升， <.01）。多变量 Cox 比例风险回归分析发现，第 4 天累积液体平衡量与 1 年死亡率独立相关（调整 HR 1.227，95%CI：1.132-1.329）。第 1 至 4 天累积正液体平衡与癌症危重症患者 1 年生存率缩短相关。需要进一步的研究来验证这一关联。
