Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication
Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication
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DOI：
10.1097/00003246-200301000-00017
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发表时间：
2003-01-01
影响因子：
8.8
通讯作者：
Colardyn, FA
中科院分区：
文献类型：
--
作者：
Benoit, DD;Vandewoude, KH;Colardyn, FA
目的：评估全球因危及生命的并发症而入住重症监护病房的血液恶性肿瘤患者的预后并确定早期预后指标。设计：回顾性观察性研究。环境：一所三级大学医院的重症监护室。患者：在3.5年的时间里，共有124名患有血液恶性肿瘤的危重患者连续住进重症监护室。测量：我们收集了入院时和入院期间的变量，并通过逐步逻辑回归分析确定了住院死亡率的预测因素。主要结果：急性生理和慢性健康评估II平均评分为26 +/- 7.7分。61%为高度恶性肿瘤，27%为活动性疾病。入院时35%的白细胞减少（白细胞计数0.75 g/L (bbb12 mmol/L)）与预后不良相关（优势比9.4；95%可信区间4.2-26），而近期菌血症（优势比0.17；95%可信区间0.05-0.58）与预后较好相关。使用这些变量，我们将人群随机分为三组进行生存分析：低风险组（低尿素伴或不伴白细胞减少或血管加压物，n = 60），中等风险组（高尿素或白细胞减少和血管加压物联合，n = 34）和高风险组（高尿素伴白细胞减少或血管加压物，n = 27）。引起重症监护病房住院的菌血症患者被分配到低一级风险组。第1组30天和6个月的生存率分别为75%和55%，第2组为35%和21%，第3组为4%和0% （p < 0.001）。结论：一般不愿接纳血液恶性肿瘤患者到重症监护病房，即使是严重的危重疾病，是不合理的。然而，我们确定了四个早期预测结果的因素，这些因素可能对决定哪些患者不应继续进行晚期或长期支持有价值。
Objectives: To assess the outcome and to identify early prognostic indicators in a global population of patients with hematologic malignancy admitted to the intensive care unit for a life-threatening complication.Design: Retrospective observational study.Setting: Medical intensive care unit at a tertiary university hospital.Patients: A total of 124 consecutive critically ill patients with a hematologic malignancy admitted to the intensive care unit during a 3.5-yr period.Measurements: We collected variables at admission and during admission and identified predictors of in-hospital mortality by stepwise logistic regression analysis.Main Results: Mean Acute Physiology and Chronic Health Evaluation II score was 26 +/- 7.7. Sixty-one percent had a high-grade malignancy, and 27% had active disease. Thirty-five percent were leukopenic (leukocyte count, 0.75 g/L (>12 mmol/L) (odds ratio, 9.4; 95% confidence interval, 4.2-26) at admission were associated with poor outcome, whereas recent bacteremia (odds ratio, 0.17; 95% confidence interval, 0.05-0.58) was associated with better prognosis. Using these variables, we arbitrarily categorized our population into three groups for survival analysis: a low-risk group (low urea with or without either leukopenia or vasopressors, n = 60), an intermediate-risk group (high urea or a combination of leukopenia and vasopressors, n = 34), and a high-risk group (high urea in combination with leukopenia or vasopressors, n = 27). Patients with a bacteremia prompting intensive care unit admission were allocated to a one-step-lower risk group. Survival probabilities at 30 days and 6 months were 75% and 55% in the first group, 35% and 21% in the second group, and 4% and 0%, respectively, in the third group (p < .001).Conclusion: The general reluctance to admit patients with a hematologic malignancy to the intensive care unit, even with severe critical illness, is unjustified. However, we identified four early predictors of outcome that may be of value in deciding in which patients advanced or prolonged support should not be continued.