Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies
Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies
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DOI：
10.1093/ndt/gfh637
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发表时间：
2005-03-01
影响因子：
6.1
通讯作者：
Decruyenaere, JM
中科院分区：
文献类型：
--
作者：
Benoit, DD;Hoste, EA;Decruyenaere, JM
背景。对于患有血液系统恶性肿瘤的危重患者，开始进行肾脏替代治疗（RRT）治疗急性肾功能衰竭是有争议的，因为其结果不佳且费用较高。本研究的目的是比较患有和不患有血液系统恶性肿瘤的危重内科患者因急性肾衰竭而接受 RRT 的结果。方法。我们回顾性收集了1997年至2002年间在某大学医院重症监护病房（ICU）接受急性肾功能衰竭的所有连续患者的数据，并通过Cox比例风险模型评估了血液系统恶性肿瘤的存在对入住ICU后6个月内生存的影响。结果。在研究期间，连续入住 ICU 的 222 名血液恶性肿瘤患者中，有 50 名 (22.5%) 因急性肾衰竭接受了 RRT，而 4293 名非血液恶性肿瘤患者中，有 248 名 (5.8%) 接受了 RRT (P < 0.001)。在接受 RRT 的患者中，根据 Kaplan-Meier 估计，与未接受血液系统恶性肿瘤的患者相比，患有血液系统恶性肿瘤的患者的 ICU 粗死亡率（79.6 vs 55.7%，P = 0.002）和院内死亡率（83.7 vs 66.1%，P = 0.016）更高，并且 6 个月时的死亡率更高（86 vs 72%，P = 0.018）。恶性肿瘤。然而，在调整病情严重程度和入住 ICU 之前的住院时间后，血液恶性肿瘤本身不再与较高的死亡风险相关（风险比 1.04；95% 置信区间，0.73-1.54，P = 0.78）。结论。与非血液恶性肿瘤患者相比，内科 ICU 内科 ICU 血液恶性肿瘤患者接受 RRT 治疗后急性肾功能衰竭的发生率更高，死亡率也更高。然而，血液系统恶性肿瘤本身的存在并不是对患有急性肾功能衰竭的 ICU 患者停止 RRT 的理由。
Background. Starting renal replacement therapy (RRT) for acute renal failure in critically ill patients with haematological malignancies is controversial because of the poor outcome and high costs. The aim of this study was to compare the outcome between critically ill medical patients with and without haematological malignancies who received RRT for acute renal failure.Methods. We retrospectively collected data on all consecutive patients who received RRT for acute renal failure at the Medical Intensive Care Unit (ICU) of a University Hospital between 1997 and 2002, and assessed the impact of the presence of a haematological malignancy on the survival within 6 months after ICU admission by Cox proportional hazard models.Results. Fifty of the 222 (22.5%) consecutive patients with haematological malignancies admitted to the ICU over the study period received RRT for acute renal failure compared with 248 of the 4293 (5.8%) patients without haematological malignancies (P < 0.001). Among patients who received RRT, those with haematological malignancies had higher crude ICU (79.6 vs 55.7%, P=0.002) and in-hospital (83.7 vs 66.1%, P = 0.016) mortality rates, and a higher mortality at 6 months (86 vs 72%, P = 0.018) by Kaplan-Meier estimates compared with those without haematological malignancies. However, after adjustment for the severity of illness and the duration of hospitalization before ICU admission, haematological malignancy by itself was no longer associated with a higher risk of death (hazard ratio 1.04; 95% confidence interval, 0.73-1.54, P = 0.78).Conclusions. Medical ICU patients with haematological malignancies have a higher rate of occurrence of acute renal failure treated with RRT and a higher mortality, compared with those without haematological malignancies. However, the presence of a haematological malignancy by itself is not a reason to withhold RRT in medical ICU patients with acute renal failure.