Vigneron Clara, Laousy Othmane, Chassagnon Guillaume, Vakalopoulou Maria, Charpentier Julien, Alexandre Jérôme, Jamme Matthieu, Pène Frédéric
Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, 75014 Paris, France.
Université Paris Cité, 75014 Paris, France.
Cancers (Basel). 2022 Nov 29;14(23):5870. doi: 10.3390/cancers14235870.
Simple and accessible prognostic factors are paramount for solid cancer patients experiencing life-threatening complications. The aim of this study is to appraise the impact of functional and nutritional status and skeletal muscle mass in this population. We conducted a retrospective (2007−2020) single-center study by enrolling adult patients with solid cancers requiring unplanned ICU admission. Performance status, body weight, and albumin level were collected at ICU admission and over six months. Skeletal muscle mass was assessed at ICU admission by measuring muscle areas normalized by height (SMI). Four-hundred and sixty-two patients were analyzed, mainly with gastro-intestinal (34.8%) and lung (29.9%) neoplasms. Moreover, 92.8% of men and 67.3% of women were deemed cachectic. In the multivariate analysis, performance status at ICU admission (CSH 1.74 [1.27−2.39], p < 0.001) and the six month increase in albumin level (CSH 0.38 [0.16−0.87], p = 0.02) were independent predictors of ICU mortality. In the subgroup of mechanically ventilated patients, the psoas SMI was independently associated with ICU mortality (CSH 0.82 [0.67−0.98], p = 0.04). Among the 368 ICU-survivors, the performance status at ICU admission (CSH 1.34 [1.14−1.59], p < 0.001) and the six-month weight loss (CSH 1.33 [1.17−2.99], p = 0.01) were associated with a one-year mortality rate. Most cancer patients displayed cachexia at ICU admission. Time courses of nutritional parameters may aid the prediction of short- and long-term outcomes.
对于面临危及生命并发症的实体癌患者而言，简单且易于获取的预后因素至关重要。本研究旨在评估功能和营养状况以及骨骼肌质量对该人群的影响。我们进行了一项回顾性（2007 - 2020年）单中心研究，纳入了因计划外入住重症监护病房（ICU）的成年实体癌患者。在患者入住ICU时及之后的六个月内收集其体能状态、体重和白蛋白水平。通过测量经身高标准化的肌肉面积（SMI）在入住ICU时评估骨骼肌质量。共分析了462例患者，主要患有胃肠道肿瘤（34.8%）和肺癌（29.9%）。此外，92.8%的男性和67.3%的女性被认为患有恶病质。在多变量分析中，入住ICU时的体能状态（校正危险比[CSH] 1.74 [1.27 - 2.39]，p < 0.001）和白蛋白水平在六个月内的升高（CSH 0.38 [0.16 - 0.87]，p = 0.02）是ICU死亡率的独立预测因素。在机械通气患者亚组中，腰大肌SMI与ICU死亡率独立相关（CSH 0.82 [0.67 - 0.98]，p = 0.04）。在368例ICU幸存者中，入住ICU时的体能状态（CSH 1.34 [1.14 - 1.59]，p < 0.001）和六个月内的体重减轻（CSH 1.33 [1.17 - 2.99]，p = 0.01）与一年死亡率相关。大多数癌症患者在入住ICU时表现出恶病质。营养参数的时间进程可能有助于预测短期和长期预后。
