Singh Suvir, Sharma Rintu, Singh Jagdeep, Jain Kunal, Kaur Gurkirat, Gupta Vivek, Gautam P L
Department of Clinical Hematology and Stem Cell Transplantation, Bone Marrow Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab 141001 India.
Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, India.
Indian J Hematol Blood Transfus. 2024 Jul;40(3):423-431. doi: 10.1007/s12288-024-01757-3. Epub 2024 Mar 25.
Outcomes of patients with hematologic malignancies requiring ICU care for critical illness are suboptimal and represent a major unmet need in this population. We present data from a dedicated haematology oncology setting including 63 patients with a median age of 60 years admitted to the ICU for critical illness with organ dysfunction. The most common underlying diagnosis was multiple myeloma (30%) followed by acute myeloid leukemia (25%). Chemotherapy had been initiated for 90.7% patients before ICU admission. The most common indication for ICU care was respiratory failure (36.5%) and shock (17.5%) patients. Evidence of sepsis was present in 44 (69%) patients. After shifting to ICU, 32 (50%) patients required inotropic support and 18 (28%) required invasive mechanical ventilation. After a median of 5 days of ICU stay, 43.1% patients had died, most commonly due to multiorgan dysfunction. Risk of mortality was higher with involvement of more than two major organs ( = .001), underlying AML ( = .001), need for mechanical ventilation ( = .001) and high inotrope usage ( = .004). Neutropenia was not associated with mortality. Our study indicates high rates of short term mortality and defines prognostic factors which can be used to prognosticate patients and establish goals of care.
The online version contains supplementary material available at 10.1007/s12288-024-01757-3.
需要重症监护病房（ICU）护理的血液系统恶性肿瘤患者的预后不理想，是这一人群中尚未满足的主要需求。我们展示了来自专门血液肿瘤科室的数据，包括63名因器官功能障碍而入住ICU进行重症治疗的患者，中位年龄为60岁。最常见的潜在诊断是多发性骨髓瘤（30%），其次是急性髓系白血病（25%）。90.7%的患者在入住ICU前已开始化疗。入住ICU最常见的指征是呼吸衰竭（36.5%）和休克（17.5%）患者。44名（69%）患者有脓毒症证据。转入ICU后，32名（50%）患者需要使用血管活性药物支持，18名（28%）患者需要有创机械通气。在ICU中位住院5天后，43.1%的患者死亡，最常见的原因是多器官功能障碍。涉及两个以上主要器官（P = 0.001）、潜在的急性髓系白血病（P = 0.001）、需要机械通气（P = 0.001）和高剂量血管活性药物使用（P = 0.004）时，死亡风险更高。中性粒细胞减少与死亡率无关。我们的研究表明短期死亡率很高，并确定了可用于预测患者预后和确立治疗目标的预后因素。
在线版本包含可在10.1007/s12288-024-01757-3获取的补充材料。
