Characteristics and outcomes of patients with cancer requiring admission to intensive care units: A prospective multicenter study
Characteristics and outcomes of patients with cancer requiring admission to intensive care units: A prospective multicenter study
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DOI：
10.1097/ccm.0b013e3181c0349e
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发表时间：
2010-01-01
影响因子：
8.8
通讯作者：
Salluh, Jorge I. F.
中科院分区：
文献类型：
--
作者：
Soares, Marcio;Caruso, Pedro;Salluh, Jorge I. F.
目的：评价几家重症监护病房收治的癌症患者的特点和预后。对需要重症监护的癌症患者的了解主要局限于单中心研究。设计：前瞻性、多中心、队列研究。环境：巴西28家医院的重症监护病房。患者：在2个月的时间内，共纳入717例连续患者。干预措施:没有。测量结果及主要结果：667例（93%）患者存在实体瘤，50例（7%）患者存在血液恶性肿瘤。进入重症监护病房的主要原因是术后护理（57%）、败血症（15%）和呼吸衰竭（10%）。住院总死亡率为30%，因内科并发症入院的患者死亡率（58%）高于急诊患者（37%）和计划手术患者（11%）（p < 0.001）。调整除入院类型、重症监护病房入院前住院天数（优势比[OR]， 1.18； 95%可信区间[CI]， 1.01-1.37）、序序性器官衰竭评估评分较高（OR, 1.25; 95% CI, 1.17-1.34）、表现不佳（OR, 3.40; 95% CI, 2.19-5.26）、需要机械通气（OR, 2.42; 95% CI, 1.51-3.87）和复发或进展中的活动性潜在恶性肿瘤(OR, 2.42；在多变量分析中，95% CI, 1.51-3.87)与住院死亡率增加相关。结论：这项大型多中心研究报告了需要重症监护的癌症患者令人鼓舞的生存率。在这些患者中，死亡率主要取决于器官衰竭的严重程度、功能状态和机械通气的需要，而不是癌症相关的特征，如恶性肿瘤的类型或中性粒细胞减少的存在。（急救医疗2010；38:9-15）
Objective: To evaluate the characteristics and outcomes of patients with cancer admitted to several intensive care units. Knowledge on patients with cancer requiring intensive care is mostly restricted to single-center studies.Design: Prospective, multicenter, cohort study.Setting: Intensive care units from 28 hospitals in Brazil.Patients: A total of 717 consecutive patients included over a 2-mo period.Interventions: None.Measurements and Main Results: There were 667 (93%) patients with solid tumors and 50 (7%) patients had hematologic malignancies. The main reasons for intensive care unit admission were postoperative care (57%), sepsis (15%), and respiratory failure (10%). Overall hospital mortality rate was 30% and was higher in patients admitted because of medical complications (58%) than in emergency (37%) and scheduled (11%) surgical patients (p < .001). Adjusting for covariates other than the type of admission, the number of hospital days before intensive care unit admission (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.37), higher Sequential Organ Failure Assessment scores (OR, 1.25; 95% CI, 1.17-1.34), poor performance status (OR, 3.40; 95% CI, 2.19-5.26), the need for mechanical ventilation (OR, 2.42; 95% CI, 1.51-3.87), and active underlying malignancy in recurrence or progression (OR, 2.42; 95% CI, 1.51-3.87) were associated with increased hospital mortality in multivariate analysis.Conclusions: This large multicenter study reports encouraging survival rates for patients with cancer requiring intensive care. In these patients, mortality was mostly dependent on the severity of organ failures, performance status, and need for mechanical ventilation rather than cancer-related characteristics, such as the type of malignancy or the presence of neutropenia. (Crit Care Med 2010; 38:9-15)