Abdel-Nabey Moustafa, Chaba Anis, Serre Justine, Lengliné Etienne, Azoulay Elie, Darmon Michael, Zafrani Lara
Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
University of Paris, Paris, France.
Ann Intensive Care. 2022 Feb 15;12(1):15. doi: 10.1186/s13613-022-00990-1.
Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year.
Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02-1.34]), age (OR = 1.05, IC 95% [1.02-1.08]) and male gender (OR = 6.79, IC 95% [2.59-19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17-5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02-3.78]), vasopressors (HR = 3.13, IC 95% [1.59-6.15]), age (HR = 1.02, IC 95% [1-1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01-2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1-1.03]).
AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes.
肿瘤溶解综合征（TLS）是恶性肿瘤治疗期间一种危及生命的并发症。我们试图描述高危TLS患者急性肾损伤（AKI）、缓解情况及死亡率的特征和预测因素。在这项回顾性单中心研究中，我们纳入了2012年至2018年期间所有诊断为生物学和/或临床TLS的患者。主要结局是TLS急性期AKI的发生率。次要结局是1年时的总体死亡率和潜在恶性肿瘤的缓解情况。
在153例TLS患者中，123例（80.4%）发生了AKI，83例（54.2%）需要肾脏替代治疗。改良序贯器官衰竭评估（mSOFA）评分（OR = 1.15，95%置信区间[1.02 - 1.34]）、年龄（OR = 1.05，95%置信区间[1.02 - 1.08]）和男性性别（OR = 6.79，95%置信区间[2.59 - 19.44]）与AKI相关。使用拉布立酶（HR = 2.45，95%置信区间[1.17 - 5.15]）与1年时潜在恶性肿瘤的缓解相关。与1年死亡率相关的参数有机械通气（HR = 1.96，95%置信区间[1.02 - 3.78]）、血管升压药（HR = 3.13，95%置信区间[1.59 - 6.15]）、年龄（HR = 1.02，95%置信区间[1 - 1.03]）、自发性TLS（HR = 1.65，95%置信区间[1.01 - 2.69]）和化疗给药延迟（HR = 1.01，95%置信区间[1 - 1.03]）。
AKI在TLS患者中非常普遍。拉布立酶与潜在恶性肿瘤缓解方面的更好结局相关。由于拉布立酶可能是高度肿瘤溶解和化疗敏感性的间接标志物，需要更多研究来证实尿酸氧化酶的保护作用。延迟化疗在长期结局方面可能有害。
