Emergency Care for Patients with Cancer on Immune Checkpoint Inhibitors: A Retrospective Analysis of Immune-Related Adverse Events

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-08-21 DOI:10.1016/j.jemermed.2025.08.025

Alice Ferrua , Jacopo Davide Giamello , Chiara Fulcheri , Michela Milanesio , Giulia Bernardi , Elena Fea , Salvatore D’Agnano , Nicoletta Artana , Daniela Caruso , Giovanna Greco , Tiziana Ponza , Enrico Lupia , Luigi Fenoglio , Giuseppe Lauria , Gianmauro Numico

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引用次数: 0

Abstract

Background

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but can lead to immune-related adverse events (irAEs), some of which require emergency care.

Objective

To evaluate the prevalence, clinical features and outcomes of emergency department (ED) visits related to irAEs among patients receiving ICIs.

Methods

We retrospectively reviewed ED visits from 2013 to 2021 among patients with solid tumors treated with ICIs at a single tertiary cancer center in Italy. Each visit was independently reviewed and classified as definitely, potentially, or not related to irAEs.

Results

Of 457 ED visits from 216 patients, 27 (5.9%) were definitely and 15 (3.3%) potentially related to irAEs. The most frequent irAEs were pneumonitis (n = 19), colitis (n = 5), and hepatitis (n = 3). Dyspnea was more common in irAE-related visits (28.6% vs 13%, p = 0.006). 74.1% of irAE-related visits resulted in hospital admission and 30-day mortality was 14.3%. The median time from ICI initiation to ED presentation for irAEs was 21 weeks.

Conclusions

irAEs account for a significant portion of ED visits in patients receiving ICIs, with pneumonitis being the most frequent. Emergency clinicians should be aware of this delayed toxicity spectrum, especially in patients presenting with respiratory symptoms.

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使用免疫检查点抑制剂的癌症患者的急诊护理：免疫相关不良事件的回顾性分析

免疫检查点抑制剂（ICIs）已经改变了癌症治疗，但可能导致免疫相关不良事件（irAEs），其中一些需要紧急护理。目的评价接受体外循环（ici）的患者与irae相关的急诊科（ED）就诊情况、临床特征及转归。方法：我们回顾性回顾了2013年至2021年在意大利单一三级癌症中心接受ICIs治疗的实体肿瘤患者的ED就诊情况。每次访问都被独立审查，并被分类为肯定、潜在或与irae无关。结果216例患者的457次ED就诊中，27例（5.9%）与irAEs明确相关，15例（3.3%）与潜在相关。最常见的irae是肺炎（n = 19）、结肠炎（n = 5）和肝炎（n = 3）。呼吸困难在irae相关就诊中更为常见（28.6% vs 13%, p = 0.006）。与irae相关的就诊有74.1%导致住院，30天死亡率为14.3%。irAEs从ICI开始到出现ED的中位时间为21周。结论：在接受ici的患者中，急诊占ED就诊的很大一部分，其中肺炎是最常见的。急诊临床医生应该意识到这种延迟毒性谱，特别是在出现呼吸道症状的患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine