Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study

IF 21.2 1区 医学 Q1 CRITICAL CARE MEDICINE
Peter Schellongowski, Michael Darmon, Philipp Eller, Laveena Munshi, Tobias Liebregts, Victoria Metaxa, Luca Montini, Tobias Lahmer, Fabio S. Taccone, Andry van de Louw, Martin Balik, Peter Pickkers, Pleun Hemelaar, Hemang Yadav, Andreas Barratt-Due, Thomas Karvunidis, Jordi Riera, Gennaro Martucci, Ignacio Martin-Loeches, Pedro Castro, Nina Buchtele, Virginie Lemiale, Stefan Hatzl, Guillaume Dumas, Thomas Staudinger, Elie Azoulay
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Abstract

Purpose

Acute respiratory failure is the leading reason for intensive care unit (ICU) admission among critically ill patients with cancer. We aimed to describe the clinical characteristics, risk factors, and outcomes of patients with cancer and acute respiratory distress syndrome (ARDS) and to evaluate associations of venovenous extracorporeal membrane oxygenation (ECMO) with outcomes in the subgroup with severe ARDS.

Methods

We conducted a multinational, prospective, observational cohort study of patients with cancer and ARDS in 13 countries in Europe and North America. The primary endpoint was 90-day mortality.

Results

Among 715 included patients, 73.4% had hematologic malignancies and 26.6% solid tumors; 31.2% had undergone hematopoietic stem-cell transplantation (168 allogeneic). ICU, hospital, and 90-day mortality rates were 55.3%, 70.9%, and 73.2%, respectively. By multivariate analysis, independent predictors of higher 90-day mortality were older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial (vs. full code). Conversely, lymphoma was associated with lower 90-day mortality. Among the 322 patients (45.7%) with severe ARDS at inclusion, 90-day mortality was 82.2%; with no difference between patients who received ECMO (n = 58, 18%) and those who did not (82.6% vs. 80.7%, P = 0.89). This finding remained unchanged in a double-adjusted overlap- and propensity-weighted Cox mixed-effects model (adjusted hazard ratio, 1.12; 95% confidence interval 0.65–1.94; P = 0.69).

Conclusion

Patients with cancer and ARDS, particularly severe forms, experience high 90-day mortality, irrespective of ECMO use. These findings suggest a need for nuanced ICU goals-of-care discussions and raise concerns about the generalizability of ECMO guidelines to this population.

癌症患者的急性呼吸窘迫综合征:YELENNA前瞻性多国观察队列研究
目的急性呼吸衰竭是危重癌症患者入住重症监护病房(ICU)的主要原因。我们旨在描述癌症合并急性呼吸窘迫综合征(ARDS)患者的临床特征、危险因素和结局,并评估静脉-静脉体外膜氧合(ECMO)与严重ARDS亚组预后的关系。方法我们对欧洲和北美13个国家的癌症和ARDS患者进行了一项多国、前瞻性、观察性队列研究。主要终点为90天死亡率。结果715例患者中,恶性血液病占73.4%,实体瘤占26.6%;31.2%的患者接受过造血干细胞移植(异体造血168例)。ICU、医院和90天死亡率分别为55.3%、70.9%和73.2%。通过多变量分析,较高的90天死亡率的独立预测因素是年龄较大、周围血管疾病、纳入时严重的ARDS、急性肾损伤和作为有时间限制的试验入住ICU(相对于完整代码)。相反,淋巴瘤与较低的90天死亡率相关。纳入时322例(45.7%)严重ARDS患者,90天死亡率为82.2%;接受ECMO的患者(n = 58, 18%)和未接受ECMO的患者之间无差异(82.6%对80.7%,P = 0.89)。这一发现在双重调整的重叠加权和倾向加权Cox混合效应模型中保持不变(调整后的风险比为1.12;95%置信区间为0.65-1.94;P = 0.69)。结论:无论是否使用ECMO,癌症和ARDS患者,特别是严重形式的患者,90天死亡率都很高。这些发现提示有必要对ICU的护理目标进行细致入微的讨论,并对ECMO指南在这一人群中的普遍性提出了关注。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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