一项全国性研究，探讨需要重症监护的脓毒症癌症患者的特征和结局。

A nationwide study on characteristics and outcome of cancer patients with sepsis requiring intensive care.

机构信息

Department of Anaesthesia and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

出版信息

Acta Oncol. 2022 Aug;61(8):946-954. doi: 10.1080/0284186X.2022.2090276. Epub 2022 Jun 26.

DOI:10.1080/0284186X.2022.2090276

PMID:35758282

Abstract

BACKGROUND

Sepsis is the leading cause of admission to the intensive care unit (ICU) for cancer patients and survival rates have historically been low. The aims of this nationwide cohort study were to describe the characteristics and outcomes of cancer patients admitted to the ICU with sepsis compared with other sepsis patients requiring ICU admission.

MATERIAL AND METHODS

This was a retrospective, observational study. All adult admissions to Icelandic ICUs during years 2006, 2008, 2010, 2012, 2014 and 2016 were screened for severe sepsis or septic shock by ACCP/SCCM criteria. Clinical characteristics and outcomes of sepsis patients with cancer were compared to those without cancer.

RESULTS

In the study period, 235 of 971 (24%) patients admitted to Icelandic ICUs because of sepsis had cancer, most often a solid tumour (100), followed by metastatic tumours (69) and haematological malignancies (66). Infections were more often hospital-acquired in cancer patients (52%) than other sepsis patients (18%, < 0.001) and sites of infections differed, with abdominal infections being most common in patients with solid and metastatic tumours but lungs and bloodstream infections in haematological malignancies. The length of stay in the ICU was shorter for sepsis patients with metastatic disease than other sepsis patients (2 vs. 4 days, < 0.001) and they were more likely to have treatment limitations (52 vs. 19%, < 0.05). Median survival of patients with metastatic disease was 19 days from ICU admission. The 28-day mortality (25%) of solid tumour patients was comparable to that of sepsis patients without cancer (20%, < 0.001).

CONCLUSIONS

Cancer is a common comorbidity in patients admitted to the ICU with sepsis. The clinical presentation and outcome differs between cancer types. Individuals with metastatic cancer were unlikely to receive prolonged invasive ICU care treatment. Comparable short-term outcome was found for patients with solid tumours and no cancer.

摘要

背景

脓毒症是癌症患者入住重症监护病房（ICU）的主要原因，其生存率历来较低。本项全国性队列研究的目的是描述与其他需要入住 ICU 的脓毒症患者相比，入住 ICU 的脓毒症癌症患者的特征和结局。

材料和方法

这是一项回顾性观察性研究。通过 ACCP/SCCM 标准筛选 2006 年、2008 年、2010 年、2012 年、2014 年和 2016 年入住冰岛 ICU 的所有成年患者，以确定是否患有严重脓毒症或脓毒性休克。将癌症患者与非癌症患者的脓毒症患者的临床特征和结局进行比较。

结果

在研究期间，因脓毒症入住冰岛 ICU 的 971 例患者中有 235 例（24%）患有癌症，最常见的是实体瘤（100 例），其次是转移性肿瘤（69 例）和血液恶性肿瘤（66 例）。与其他脓毒症患者（18%，<0.001）相比，癌症患者的感染更常为医院获得性感染（52%），感染部位也不同，腹部感染是实体瘤和转移性肿瘤患者中最常见的感染部位，但肺部和血流感染是血液恶性肿瘤患者中最常见的感染部位。转移性疾病患者的 ICU 住院时间比其他脓毒症患者（2 天与 4 天，<0.001）更短，并且他们更有可能受到治疗限制（52%与 19%，<0.05）。转移性疾病患者从 ICU 入院到死亡的中位生存时间为 19 天。实体瘤患者的 28 天死亡率（25%）与无癌症的脓毒症患者（20%，<0.001）相当。