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血液恶性肿瘤危重症患者的结局和危险因素。前瞻性单中心观察性研究。

Outcomes and Risk Factors of Critically Ill Patients with Hematological Malignancy. Prospective Single-Centre Observational Study.

机构信息

Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania.

Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21/27, 03101 Vilnius, Lithuania.

出版信息

Medicina (Kaunas). 2021 Nov 30;57(12):1317. doi: 10.3390/medicina57121317.

Abstract

: Oncohematological patients have a high risk of mortality when they need treatment in an intensive care unit (ICU). The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the ICU and their risk factors. : A prospective single-center observational study was performed with 114 patients from July 2017 to December 2019. Inclusion criteria were transfer to an ICU, hematological malignancy, age >18 years, a central line or arterial line inserted or planned to be inserted, and a signed informed consent form. Univariate and multivariable logistic regression models were used to evaluate the potential risk factors for ICU mortality. : ICU mortality was 44.74%. Invasive mechanical ventilation in ICU was used for 55.26% of the patients, and vasoactive drugs were used for 77.19% of patients. Factors independently associated with it were qSOFA score ≥2, increase of SOFA score over the first 48 h, mechanical ventilation on the first day in ICU, need for colistin therapy, lower arterial pH on arrival to ICU. Cut-off value of the noradrenaline dose associated with ICU mortality was 0.21 μg/kg/min with a ROC of 0.9686 (95% CI 0.93-1.00, < 0.0001). : Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. Despite our findings, we do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline.

摘要

: 血液肿瘤患者在重症监护病房(ICU)接受治疗时死亡率较高。本研究旨在分析入住 ICU 的血液肿瘤患者的结局及其危险因素。: 本研究为前瞻性单中心观察性研究,纳入 2017 年 7 月至 2019 年 12 月期间入住 ICU 的 114 名患者。纳入标准为转入 ICU、血液恶性肿瘤、年龄>18 岁、已插入或计划插入中心静脉或动脉导管、签署知情同意书。采用单因素和多因素逻辑回归模型评估 ICU 死亡率的潜在危险因素。: ICU 死亡率为 44.74%。55.26%的患者在 ICU 中接受了有创机械通气,77.19%的患者使用了血管活性药物。与 ICU 死亡率独立相关的因素为 qSOFA 评分≥2、入住 ICU 48 小时内 SOFA 评分升高、入住 ICU 第 1 天需要机械通气、需要使用黏菌素治疗、入 ICU 时动脉 pH 值较低。与 ICU 死亡率相关的去甲肾上腺素剂量的截断值为 0.21 μg/kg/min,ROC 为 0.9686(95%CI 0.93-1.00,P<0.0001)。: ICU 中血液肿瘤患者的死亡率较高,与入住 ICU 48 小时内器官功能障碍进展、有创机械通气和需要相对较低剂量的去甲肾上腺素有关。尽管我们的研究结果表明,对于已达到去甲肾上腺素截断剂量的患者,我们不建议对治疗限制做出决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/91f3/8707137/82d9ee5c8743/medicina-57-01317-g001.jpg

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