Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA.
J Intensive Care Med. 2024 Nov;39(11):1146-1154. doi: 10.1177/08850666241253537. Epub 2024 May 9.
The aim of the study was to examine the incidence, baseline characteristics, and outcomes of Chimeric Antigen Receptor T-cell (CAR-T) therapy admissions in individuals who developed acute respiratory failure (ARF). The study utilized the National Inpatient Sample (NIS) database for the years 2017 to 2020. The study identified CAR-T cell therapy hospitalizations through the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes. Patients with acute respiratory failure (ARF) were further classified using specific International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Descriptive statistics were performed to analyze baseline characteristics, comorbidities, complications, and outcomes. Analysis of the NIS Database identified 5545 CAR-T therapy admissions between 2017 and 2020, revealing a rising trend over time. In our study, we found that hypertension (39%), dyslipidemia (21.7%), and venous thromboembolism (13%) were the most frequently observed comorbidities in CAR-T cell therapy admissions. Acute respiratory failure (ARF) was reported in 7.1% of admissions, and they had higher all-cause in-hospital mortality than CAR-T cell therapy admissions without ARF (32.9% vs 1.3%, < 0.001). ARF admissions that required invasive mechanical ventilation (IMV) also had higher all-cause in-hospital mortality compared to admissions not requiring IMV (48.9% vs 11.8%, = 0.001). There was no difference in the mortality rate among admissions with non-Hodgkin's Lymphoma, Multiple Myeloma, and Leukemia that utilized CAR-T therapy. In this largest study to date, we illuminate the incidence and outcomes of CAR-T cell therapy admissions with ARF. Higher mortality rates were observed in CAR-T cell therapy admissions with ARF. The study emphasizes the crucial role of interdisciplinary collaboration in CAR-T patient management and calls for additional research to clarify ARF's etiology and inform effective management strategies.
这项研究的目的是探讨接受嵌合抗原受体 T 细胞（CAR-T）治疗后发生急性呼吸衰竭（ARF）的患者的发病率、基线特征和结局。该研究利用了 2017 年至 2020 年的国家住院患者样本（NIS）数据库。通过国际疾病分类、第十次修订版、程序编码系统（ICD-10-PCS）代码确定 CAR-T 细胞治疗住院患者。使用特定的国际疾病分类、第十次修订版、临床修正（ICD-10-CM）代码进一步对急性呼吸衰竭（ARF）患者进行分类。采用描述性统计方法分析基线特征、合并症、并发症和结局。对 NIS 数据库的分析确定了 2017 年至 2020 年间的 5545 例 CAR-T 治疗住院患者，发现随着时间的推移呈上升趋势。在我们的研究中，我们发现高血压（39%）、血脂异常（21.7%）和静脉血栓栓塞（13%）是 CAR-T 细胞治疗住院患者最常见的合并症。报告有 7.1%的住院患者发生急性呼吸衰竭（ARF），与无 ARF 的 CAR-T 细胞治疗住院患者相比，他们的全因院内死亡率更高（32.9%对 1.3%，<0.001）。需要有创机械通气（IMV）的 ARF 住院患者与不需要 IMV 的 ARF 住院患者相比，全因院内死亡率更高（48.9%对 11.8%，=0.001）。接受 CAR-T 治疗的非霍奇金淋巴瘤、多发性骨髓瘤和白血病患者的死亡率无差异。在迄今为止最大的这项研究中，我们阐明了伴有 ARF 的 CAR-T 细胞治疗住院患者的发病率和结局。伴有 ARF 的 CAR-T 细胞治疗住院患者的死亡率更高。该研究强调了多学科协作在 CAR-T 患者管理中的关键作用，并呼吁开展更多研究以阐明 ARF 的病因，并为有效的管理策略提供信息。
