Siech Carolin, de Angelis Mario, Jannello Letizia Maria Ippolita, Di Bello Francesco, Rodriguez Peñaranda Natali, Goyal Jordan A, Tian Zhe, Saad Fred, Shariat Shahrokh F, Puliatti Stefano, Longo Nicola, de Cobelli Ottavio, Briganti Alberto, Hoeh Benedikt, Mandel Philipp, Kluth Luis A, Chun Felix K H, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.
Crit Care Med. 2025 Jan 1;53(1):e132-e139. doi: 10.1097/CCM.0000000000006496. Epub 2024 Nov 14.
To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.
DESIGN, SETTING, AND PATIENTS: Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.
None.
Of 10,915 patients, 802 (7.3%) received critical care therapy and 249 (2.4%) died in-hospital. Over time, critical care therapy rates did not differ significantly (6.6% in 2000 to 5.7% in 2019; p = 0.07), while in-hospital mortality decreased from 2.3% to 1.9% (p = 0.004). Age 71 years old or older (odds ratio [OR], 1.43; p < 0.001) and higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 3: OR, 2.92; p < 0.001 and CCI 1-2: OR, 1.45; p < 0.001) independently predicted higher critical care therapy rates. Conversely, partial nephrectomy (OR, 0.51; p = 0.003) and minimally invasive surgery (OR, 0.33; p < 0.001) predicted lower critical care therapy rates. Virtually the same associations were recorded for in-hospital mortality.
After cytoreductive nephrectomy, critical care therapy rate was 7.3% vs. in-hospital mortality was 2.4%. Of patients at highest risk of critical care therapy need were those with CCI greater than or equal to 3 and those 71 years old or older. Ideally, these patients should represent targets for thorough assessment of risk factors for complications before cytoreductive nephrectomy.
研究转移性肾癌患者减瘤性肾切除术后的重症监护治疗率。
设计、背景与患者：基于国家住院患者样本（2000 - 2019年），我们探讨了接受手术治疗的转移性肾癌患者的重症监护治疗使用情况（全胃肠外营养、有创机械通气、肾脏替代治疗、经皮内镜下胃造瘘管置入术和气管切开术）以及住院死亡率。拟合了估计的年度百分比变化和多变量逻辑回归模型。
无。
10915例患者中，802例（7.3%）接受了重症监护治疗，249例（2.4%）住院死亡。随着时间推移，重症监护治疗率无显著差异（2000年为6.6%，2019年为5.7%；p = 0.07），而住院死亡率从2.3%降至1.9%（p = 0.004）。71岁及以上（比值比[OR]，1.43；p < 0.001）和更高的合并症负担（Charlson合并症指数[CCI]≥3：OR，2.92；p < 0.001以及CCI 1 - 2：OR，1.45；p < 0.001）独立预测更高的重症监护治疗率。相反，部分肾切除术（OR，0.51；p = 0.003）和微创手术（OR，0.33；p < 0.001）预测更低的重症监护治疗率。住院死亡率的相关关联情况基本相同。
减瘤性肾切除术后，重症监护治疗率为7.3%，住院死亡率为2.4%。重症监护治疗需求风险最高的患者是CCI大于或等于3的患者以及71岁及以上的患者。理想情况下，这些患者应成为在减瘤性肾切除术前全面评估并发症危险因素的目标对象。
