Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B
Intensive Care Unit, Institut Gustave Roussy, Villejuif, France.
Eur J Cancer. 1997 Jun;33(7):1031-7. doi: 10.1016/s0959-8049(97)00042-7.
The admission of neutropenic patients to an intensive care unit (ICU) is still controversial, especially if mechanical ventilation is required. To avoid useless stays in ICU, the evaluation of the respective role of the underlying malignancy and acute organ failures might be useful for better definition of the categories of patients who could benefit from aggressive ICU support. For this purpose, we carried out a retrospective study of the charts of 107 consecutive neutropenic patients admitted to an ICU in a comprehensive cancer centre over a four-year period. The following characteristics were recorded within 24 h of admission: patient data, characteristics of neutropenia and the underlying malignancy, the type and number of organ system failures (OSFs) and simplified acute physiological scores (SAPS and SAPS II). The impact of each variable on outcome in the ICU was studied by univariate and multivariate (logistic regression) analysis. 59 patients died in the ICU (mortality rate: 55%). Patients with a haematological malignancy (n = 57, 53%) were more likely to experience respiratory failure, an underlying malignancy deemed rapidly fatal, and to have longer lasting neutropenia than patients with a solid tumour (n = 50, 47%). However, the mortality rate did not differ in the two groups (haematological malignancy 61% versus solid tumour 48%, p = 0.16). Respiratory and cardiovascular organ failure (p < 0.001 for both) correlated with mortality in the ICU. In the multiple logistic regression model, only the number of organ system failures and respiratory failure remained predictive of ICU mortality. In conclusion, the characteristics of the underlying malignancy are not relevant when deciding whether or not neutropenic patients should be admitted to an ICU. The main risk factors for death in an ICU are the number of organ failures on admission, and among them the presence of respiratory failure.
中性粒细胞减少患者入住重症监护病房（ICU）仍存在争议，尤其是在需要机械通气的情况下。为避免在ICU的无效停留，评估潜在恶性肿瘤和急性器官衰竭各自的作用，可能有助于更好地界定哪些患者群体能从积极的ICU支持中获益。为此，我们对一家综合癌症中心在四年期间连续入住ICU的107例中性粒细胞减少患者的病历进行了回顾性研究。在入院24小时内记录了以下特征：患者数据、中性粒细胞减少和潜在恶性肿瘤的特征、器官系统衰竭（OSF）的类型和数量以及简化急性生理学评分（SAPS和SAPS II）。通过单因素和多因素（逻辑回归）分析研究了每个变量对ICU结局的影响。59例患者在ICU死亡（死亡率：55%）。与实体瘤患者（n = 50，47%）相比，血液系统恶性肿瘤患者（n = 57，53%）更易发生呼吸衰竭、被认为迅速致命的潜在恶性肿瘤，且中性粒细胞减少持续时间更长。然而，两组的死亡率并无差异（血液系统恶性肿瘤为61%，实体瘤为48%，p = 0.16）。呼吸和心血管器官衰竭（两者p均<0.001）与ICU死亡率相关。在多因素逻辑回归模型中，只有器官系统衰竭的数量和呼吸衰竭仍然是ICU死亡率的预测因素。总之，在决定中性粒细胞减少患者是否应入住ICU时，潜在恶性肿瘤的特征并不相关。ICU死亡的主要危险因素是入院时器官衰竭的数量，其中存在呼吸衰竭。
