Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome
Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome
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DOI：
10.1007/s00134-005-2599-z
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发表时间：
2005-07-01
影响因子：
38.9
通讯作者：
Decruyenaere, JM
中科院分区：
文献类型：
--
作者：
Benoit, DD;Depuydt, PO;Decruyenaere, JM
目的：评估记录和临床疑似细菌感染促使血液恶性肿瘤患者入住ICU对院内死亡率的影响。设计和设置：在一所三级大学医院的14张病床的医学ICU中进行的前瞻性观察性研究。患者：共有172名连续的血液恶性肿瘤患者在4年内因危及生命的并发症而入住ICU，由一个由3名医生组成的独立小组根据其入院诊断（记录的细菌感染、临床疑似细菌感染、非细菌并发症）将其分为3个主要组，该小组对患者的结局和C反应蛋白水平不知情。结果如下：记录的细菌感染（n=42）、临床疑似细菌感染（n=40）与非细菌性并发症（n=90）的住院和6个月死亡率分别为50.0%和42.5% vs. 65.6%（p=0.09和0.02）以及56.1%和48.7% vs. 72.1%（p=0.11和0.02）。前两组的中位基线C反应蛋白水平分别为23 mg/dl和21.5 mg/dl vs. 10.7 mg/dl（p < 0.001和p=0.001）。在调整危重和基础血液学疾病的严重程度和入院前住院时间（OR 0.20; 95%CI 0.06-0.62，p=0.006）和临床疑似细菌感染（OR 0.18; 95%CI 0.06-0.53，p=0.002）后，与非细菌性并发症相比，预后更好。结论：因记录或临床疑似细菌感染而入住ICU的恶性血液病重症患者的预后优于因非细菌性并发症而入住ICU的患者。这些患者应在适当的时间内接受高级生命支持治疗。
Objective: To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies. Design and setting: Prospective observational study in a 14-bed medical ICU at a tertiary university hospital. Patients: A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels. Results: In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p < 0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications. Conclusions: Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.