Constantinescu Catalin, Moisoiu Vlad, Tigu Bogdan, Kegyes David, Tomuleasa Ciprian
Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
J Clin Med. 2023 Sep 21;12(18):6098. doi: 10.3390/jcm12186098.
Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients admitted to the ICU after having received CAR-T cell therapy.
We performed a medical literature review, which included MEDLINE, Embase, and Cochrane Library, of studies published from the inception of the databases until 2022. We conducted a systematic review with meta-analyses of proportions of several studies, including CAR-T cell-treated patients who required ICU admission. Outcomes in the meta-analysis were evaluated using the random-effects model.
We included four studies and analyzed several outcomes, including baseline characteristics and ICU-related findings. CAR-T cell recipients admitted to the ICU are predominantly males (62% CI-95% (57-66)). Of the total CAR-T cell recipients, 4% CI-95% (3-5) die in the hospital, and 6% CI-95% (4-9) of those admitted to the ICU subsequently die. One of the main reasons for ICU admission is acute kidney injury (AKI) in 15% CI-95% (10-19) of cases and acute respiratory failure in 10% CI-95% (6-13) of cases. Regarding the interventions initiated in the ICU, 18% CI-95% (13-22) of the CAR-T recipients required invasive mechanical ventilation during their ICU stay, 23% CI-95% (16-30) required infusion of vasoactive drugs, and 1% CI-95% (0.1-3) required renal replacement therapy (RRT). 18% CI-95% (13-22) of the initially discharged patients were readmitted to the ICU within 30 days, and the mean length of hospital stay is 22 days CI-95% (19-25). The results paint a current state of matter in CAR-T cell recipients admitted to the ICU.
To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the ICU admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. Studies that are looking from the perspective of intensive care are highly warranted because the available literature regarding this area is scarce.
我们的主要目的是描述接受嵌合抗原受体T细胞（CAR-T）免疫治疗的患者的基线特征、入住重症监护病房（ICU）的主要原因以及在ICU中所需的干预措施。次要目的是评估接受CAR-T细胞治疗后入住ICU的患者的不同结局（ICU死亡率）。
我们对MEDLINE、Embase和Cochrane图书馆中从数据库建立至2022年发表的研究进行了医学文献综述。我们对多项研究的比例进行了系统评价和荟萃分析，这些研究包括需要入住ICU的接受CAR-T细胞治疗的患者。荟萃分析中的结局采用随机效应模型进行评估。
我们纳入了四项研究，并分析了多个结局，包括基线特征和与ICU相关的发现。入住ICU的CAR-T细胞治疗接受者主要为男性（95%置信区间62%（57-66））。在所有CAR-T细胞治疗接受者中，4%（95%置信区间（3-5））在医院死亡，而入住ICU的患者中有6%（95%置信区间（4-9））随后死亡。入住ICU的主要原因之一是15%（95%置信区间（10-19））的病例发生急性肾损伤（AKI），10%（95%置信区间（6-13））的病例发生急性呼吸衰竭。关于在ICU启动的干预措施，18%（95%置信区间（13-22））的CAR-T治疗接受者在ICU住院期间需要有创机械通气，23%（95%置信区间（16-30））需要输注血管活性药物，1%（95%置信区间（0.1-3））需要肾脏替代治疗（RRT）。18%（95%置信区间（13-22））最初出院的患者在30天内再次入住ICU , 平均住院时间为22天（95%置信区间（19-25））。这些结果描绘了入住ICU的CAR-T细胞治疗接受者的当前状况。
为了从ICU的角度更好地理解免疫治疗相关并发症，识别病房中病情恶化的患者，降低ICU入住率，推进ICU护理，并改善这些患者的结局，应制定基于CAR-T细胞的免疫治疗的护理和研究标准。从重症监护角度进行研究非常必要，因为该领域的现有文献很少。
