Prognostic factors for neutropenic patients in an intensive care unit: Respective roles of underlying malignancies and acute organ failures
Prognostic factors for neutropenic patients in an intensive care unit: Respective roles of underlying malignancies and acute organ failures
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DOI：
10.1016/s0959-8049(97)00042-7
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发表时间：
1997-06-01
影响因子：
8.4
通讯作者：
Escudier, B
中科院分区：
文献类型：
--
作者：
Blot, F;Guiguet, M;Escudier, B
对于重症监护病房（ICU）是否收治血小板减少症患者仍存在争议，尤其是是否需要机械通气。为了避免无用的停留在ICU，潜在的恶性肿瘤和急性器官衰竭的各自作用的评价可能是有用的，更好地定义的类别的患者谁可以受益于积极的ICU支持。为此目的，我们进行了一项回顾性研究的图表107个连续的血小板减少症患者在一个综合性癌症中心的ICU在四年的时间。在入院后24小时内记录以下特征：患者数据、中性粒细胞减少症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的急性生理评分（SAPS和SAPS II）。通过单变量和多变量（logistic回归）分析研究了每个变量对ICU结局的影响。ICU死亡59例（死亡率55%）。与实体瘤患者（n = 50，47%）相比，血液学恶性肿瘤患者（n = 57，53%）更可能发生呼吸衰竭（一种被认为具有快速致死性的基础恶性肿瘤）和持续时间更长的中性粒细胞减少症。然而，两组的死亡率没有差异（血液系统恶性肿瘤61%，实体瘤48%，p = 0.16）。呼吸和心血管器官衰竭（两者p < 0.001）与ICU死亡率相关。在多元逻辑回归模型中，只有器官系统衰竭和呼吸衰竭的数量仍然是ICU死亡率的预测因素。总之，在决定是否应将贫血患者送入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，其中包括呼吸衰竭的存在。(C)1997 Elsevier Science Ltd.
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. (C) 1997 Elsevier Science Ltd.