Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study
Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study
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DOI：
10.1016/j.jcrc.2014.02.005
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发表时间：
2014-08-01
影响因子：
3.7
通讯作者：
Soares, Marcio
中科院分区：
文献类型：
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作者：
Vassalo, Juliana;Spector, Nelson;Soares, Marcio
目的：本研究的目的是评估抗磷脂抗体(APL)在危重癌症患者中的患病率及其对预后的影响。方法：这是一项在癌症中心重症监护病房住院超过48小时的成人患者的前瞻性队列研究。获得包括凝血参数在内的临床和实验室数据。结果：纳入95例患者(实体瘤79%，恶性血液病21%)，其中74%确诊为急性早幼粒细胞白血病。简化急性生理学评分中位数为3分，序贯器官衰竭评分中位数为5分(2~8分)。最常见的急性早幼粒细胞白血病是狼疮抗凝剂(61%)和抗β2糖蛋白I(32%)。血管并发症的发生率为18%，APL+和APL-患者的血管并发症发生率相似。在APL+患者中，脓毒症和需要肾脏替代治疗的情况更为常见。住院死亡率和6个月死亡率分别为44%和56%。较高的序贯器官衰竭评分(每分)(危险比[HR]=2.83[95%可信区间，1.59-5.00])、住院(HR=2.66[1.34-5.27])和D-二聚体>500 ng/dL(HR=1.89(1.04-3.44))与死亡率独立相关。调整这些协变量后，APL状态与预后无关(HR=1.22[0.60-2.47])。结论：狼疮抗凝药物在危重癌症患者中很常见。然而，在这些患者中，它们与中期存活率无关。(C)2014 Elsevier Inc.保留所有权利。
Purpose: The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients.Methods: This is a prospective cohort study in adult patients admitted to the intensive care unit for more than 48 hours at a cancer center. Clinical and laboratory data including coagulation parameters were obtained. Cox proportional hazard models were used to identify predictors of 6-month mortality.Results: Ninety-five (solid tumor, 79%; hematologic malignancies, 21%) patients were included, and aPL were identified in 74% of them. Median Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores were 51 (37-65) and 5 (2-8) points, respectively. The most frequent aPL were lupus anticoagulant (61%) and anti-beta 2 glicoprotein I (32%). Vascular complications occurred in 18% of patients and were comparable between aPL+ and aPL- patients. Sepsis and need for renal replacement therapy were more frequent in aPL+ patients. Hospital and 6-month mortality rates were 44% and 56%, respectively. Higher Sequential Organ Failure Assessment scores (each point) (hazard ratios [HR]= 2.83 [95% confidence interval, 1.59-5.00]), medical admissions (HR = 2.66 [1.34-5.27]), and D-dimer more than 500 ng/dL (HR = 1.89 (1.04-3.44]) were independently associated with mortality. After adjusting for these covariates, aPL status was not associated with outcomes (HR = 1.22 [0.60-2.47]).Conclusions: Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients. (C) 2014 Elsevier Inc. All rights reserved.