Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, 500 University Dr., Hershey, PA, 17033, USA.
Division of Hematology and Oncology, Penn State Health Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA.
Ann Hematol. 2021 Jan;100(1):229-237. doi: 10.1007/s00277-020-04197-x. Epub 2020 Sep 12.
Patients with hematological malignancies (HM) often require ICU admission, and acute respiratory or renal failure are then independent risk factors for mortality. Data are scarce on acute liver dysfunction (ALD), despite HM patients cumulating risk factors. The objective of this retrospective cohort study was to assess the prevalence of ALD in critically ill HM patients and its impact on outcome. Data of all patients with HM admitted to the medical ICU between 2008 and 2018 were extracted from electronic medical records. ALD was defined by ALT > 165 U/L, AST > 230 U/L, or total bilirubin > 4 mg/dL. Univariate and multivariate logistic regressions were used to analyze hospital mortality. Charts of survivors with ALD were reviewed to assess impact of ALD on subsequent anti-cancer treatment. We included 971 patients (60% male), age 64 (54-72) years, of whom 196 (20%) developed ALD. ALD patients were younger, more frequently had liver cirrhosis or acute leukemia, and had increased severity of illness and vital organ support needs. ALD was associated with hospital mortality in univariate (OR 4.14, 95% CI 2.95-5.80, p < 0.001) and multivariate analysis (OR 1.86, 95% CI 1.07-3.24, p = 0.03). Hospital mortality was 46% in ALD patients; among 106 survivors, a third of patients requiring therapy received it as previously planned, and half of the patients were alive at 1 year. In summary, in a large population of critically ill patients with hematological malignancies, 20% developed ALD, which was an independent risk factor for hospital mortality and occasionally altered further anti-cancer treatment.
患有血液系统恶性肿瘤（HM）的患者通常需要入住 ICU，急性呼吸或肾功能衰竭是导致死亡率升高的独立危险因素。尽管 HM 患者有多种累积的危险因素，但有关急性肝功能障碍（ALD）的数据却很少。本回顾性队列研究的目的是评估危重症 HM 患者中 ALD 的发生率及其对预后的影响。从电子病历中提取了 2008 年至 2018 年间入住内科 ICU 的所有 HM 患者的数据。通过 ALT>165 U/L、AST>230 U/L 或总胆红素>4 mg/dL 定义 ALD。使用单因素和多因素逻辑回归分析医院死亡率。对 ALD 幸存者的图表进行了审查，以评估 ALD 对随后的抗癌治疗的影响。我们纳入了 971 例（60%为男性）患者，年龄 64（54-72）岁，其中 196 例（20%）发生了 ALD。ALD 患者更年轻，更常患有肝硬化或急性白血病，且疾病严重程度和重要器官支持需求更高。单因素（OR 4.14，95%CI 2.95-5.80，p<0.001）和多因素分析（OR 1.86，95%CI 1.07-3.24，p=0.03）均显示 ALD 与医院死亡率相关。ALD 患者的医院死亡率为 46%；在 106 例幸存者中，三分之一需要治疗的患者按原计划接受了治疗，一半患者在 1 年内存活。总之，在大量患有血液系统恶性肿瘤的危重症患者中，20%发生了 ALD，这是医院死亡率的独立危险因素，并且偶尔会改变进一步的抗癌治疗。
