Yuan Zhen-Nan, Wang Hai-Jun, Qu Shi-Ning, Huang Chu-Lin, Wang Hao, Zhang Hao, Yang Quan-Hui, Xing Xue-Zhong
Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Transl Cancer Res. 2020 Oct;9(10):6221-6231. doi: 10.21037/tcr-20-1324.
Advances in oncology led to a substantial increase in the number of patients requiring admission to the intensive care unit (ICU). It remains controversial to start continuous renal replacement therapy (CRRT) for acute kidney injure (AKI) in critically ill patients with cancer because of the poor outcome and high costs.
In this retrospective study, we collected data from patients with cancer with postoperative AKI-stage 3 [Kidney Disease: Improving Global Outcomes (KDIGO), 2012] undergoing CRRT in the ICU of Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to January 2019. Patients were followed up until the time of death or the point of 28-day after ICU admission. Univariate and multivariate analysis was performed to identify risk factors for 28-day survive.
Of 8,030 cancer patients after surgical operation admitted by ICU, a total of 86 (1.1%) patients developed postoperative AKI: male/female: 62/24, median age 61 [27-82] years. The number of digestive tract/lung/other types of cancer was 59, 10 and 17, respectively. The median Simplified Acute Physiology Score III (SAPS III) was 65 [49-109] and the median Sequential Organ Failure Assessment (SOFA) score was 6 [1-19]. There were 35 deaths eventually and all the deaths occur within 28 days after ICU admission. Twenty-eight-day survive rate was 57.1%±5.8%. In multivariate cox regression analysis, two risk factors independently affected 28-day survive: SAPS III score ≥65 [hazard ratio (HR): 3.451 (1.272-9.365), P=0.015], the presence of shock at the start of CRRT [HR: 10.262 (2.210-47.660), P=0.003]. The cancer status (P=0.076), cancer types (P>0.05 for both) and neoadjuvant therapy associated with cancer (P=0.949) showed no effects on 28-day survive.
For cancer patients, postoperative AKI-stage 3 is a serious complication with a low 28-day survive rate. Patients with the presence shock at the start of CRRT or SAPS III ≥65 will have a poor 28-day survive. It should be emphasized that the cancer characteristics (status, types or treatment) don't affect 28-day survive.
肿瘤学的进展导致需要入住重症监护病房（ICU）的患者数量大幅增加。对于患有癌症的重症患者因急性肾损伤（AKI）而启动连续性肾脏替代治疗（CRRT）仍存在争议，因为其预后较差且成本高昂。
在这项回顾性研究中，我们收集了2010年1月至2019年1月在中国医学科学院肿瘤医院ICU接受CRRT治疗的术后AKI 3期（《肾脏病：改善全球预后》（KDIGO），2012年）癌症患者的数据。对患者进行随访直至死亡或ICU入院后28天。进行单因素和多因素分析以确定28天生存的危险因素。
在ICU收治的8030例癌症手术后患者中，共有86例（1.1%）患者发生术后AKI：男性/女性为62/24，中位年龄61岁[27 - 82岁]。消化道/肺部/其他类型癌症的数量分别为59、10和17例。简化急性生理学评分III（SAPS III）中位数为65[49 - 109]，序贯器官衰竭评估（SOFA）评分中位数为6[1 - 19]。最终有35例死亡，所有死亡均发生在ICU入院后28天内。28天生存率为57.1%±5.8%。在多因素Cox回归分析中，两个危险因素独立影响28天生存：SAPS III评分≥65[风险比（HR）：3.451（1.272 - 9.365），P = 0.015]，CRRT开始时存在休克[HR：10.262（2.210 - 47.660），P = 0.003]。癌症状态（P = 0.076）、癌症类型（两者P均>0.05）以及与癌症相关的新辅助治疗（P = 0.949）对28天生存均无影响。
对于癌症患者，术后AKI 3期是一种严重并发症，28天生存率较低。CRRT开始时存在休克或SAPS III≥65的患者28天生存情况较差。应强调的是，癌症特征（状态、类型或治疗）不影响28天生存。
