癌症是危重症患者急性呼吸窘迫综合征的独立危险因素：一项单中心回顾性队列研究。
Cancer Is an Independent Risk Factor for Acute Respiratory Distress Syndrome in Critically Ill Patients: A Single Center Retrospective Cohort Study.
机构信息
Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
出版信息
J Intensive Care Med. 2022 Mar;37(3):385-392. doi: 10.1177/08850666211005422. Epub 2021 Mar 29.
BACKGROUND
Acute Respiratory Distress Syndrome (ARDS) is a frequent cause of respiratory failure in intensive care unit (ICU) patients and results in significant morbidity and mortality. ARDS often develops as a result of a local or systemic inflammatory insult. Cancer can lead to systemic inflammation but whether cancer is an independent risk factor for developing ARDS is unknown. We hypothesized that critically ill cancer patients admitted to the ICU were at increased risk for the diagnosis of ARDS.
METHODS
Retrospective cohort study of critically ill patients admitted between July 2017 and December 2018 at an academic medical center in Columbus, Ohio. The primary outcome was the association of patients with malignancy and the diagnosis of ARDS in a multivariable logistic regression model with covariables selected a priori informed through the construction of a directed acyclic graph.
RESULTS
412 ARDS cases were identified with 166 of those patients having active cancer. There was an association between cancer and ARDS, with an odds ratio (OR) of 1.55 (95% CI 1.26-1.92, < 0.001). When adjusted for our pre-specified confounding variables, the association remained statistically significant (OR 1.57, 95% CI 1.15-2.13, = 0.004). In an unadjusted pre-specified subgroup analysis, hematologic malignancy (OR 1.81, 95% CI 1.30-2.53, < 0.001) was associated with increased odds of developing ARDS while non-metastatic solid tumors (OR 0.51, 95% CI 0.31-0.85, = 0.01) had statistically significant negative association. Cancer patients with ARDS had a significantly higher ICU (70.5% vs 39.8%, < 0.001) and hospital (72.9% vs 40.7%, < 0.001) mortality compared to ARDS patients without active malignancy.
CONCLUSION
In this single center retrospective cohort study, cancer was found to be an independent risk factor for the diagnosis of ARDS in critically ill patients. To our knowledge, we are the first report an independent association between cancer and ARDS in critically ill patients.
背景
急性呼吸窘迫综合征（ARDS）是重症监护病房（ICU）患者呼吸衰竭的常见原因，导致发病率和死亡率显著增加。ARDS 通常是由局部或全身炎症损伤引起的。癌症可导致全身炎症，但癌症是否是发生 ARDS 的独立危险因素尚不清楚。我们假设入住 ICU 的重症癌症患者发生 ARDS 的风险增加。
方法
这是一项在俄亥俄州哥伦布市的一家学术医疗中心于 2017 年 7 月至 2018 年 12 月期间进行的重症患者回顾性队列研究。主要结局是多变量逻辑回归模型中恶性肿瘤患者与 ARDS 诊断之间的关联，协变量是通过有向无环图（DAG）构建预先选择的。
结果
确定了 412 例 ARDS 病例，其中 166 例患者患有活动性癌症。癌症与 ARDS 之间存在关联，优势比（OR）为 1.55（95%CI 1.26-1.92，<0.001）。调整了我们预先指定的混杂变量后，关联仍然具有统计学意义（OR 1.57，95%CI 1.15-2.13，=0.004）。在未调整的预先指定亚组分析中，血液恶性肿瘤（OR 1.81，95%CI 1.30-2.53，<0.001）与发生 ARDS 的几率增加相关，而非转移性实体瘤（OR 0.51，95%CI 0.31-0.85，=0.01）具有统计学意义的负相关。患有 ARDS 的癌症患者的 ICU（70.5% vs 39.8%，<0.001）和医院（72.9% vs 40.7%，<0.001）死亡率明显高于无活动性恶性肿瘤的 ARDS 患者。
结论
在这项单中心回顾性队列研究中，发现癌症是重症患者发生 ARDS 的独立危险因素。据我们所知，我们首次报告了癌症与重症患者 ARDS 之间的独立关联。
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