血液恶性肿瘤患者急性呼吸窘迫综合征:一项为期一年的全国性回顾性队列研究

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Pierre-Nicolas Bris, Vanessa Pauly, Véronica Orleans, Jean-Marie Forel, Pascal Auquier, Laurent Papazian, Laurent Boyer, Sami Hraiech
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引用次数: 0

摘要

背景血液恶性肿瘤(HM)患者发生的急性呼吸窘迫综合征(ARDS)是一种具有特殊特征的危及生命的疾病。虽然死亡率居高不下,但过去几年来情况有所改善。我们的目的是描述在法国重症监护病房(ICU)住院的血液恶性肿瘤患者在一年内发生 ARDS 的特征和结果。这项全国性队列研究的数据来自法国国家医院数据库(PMSI)。研究对象包括2017年入住法国重症监护病房、诊断为ARDS的所有患者(18岁或以上)。根据是否患有HM、实体瘤或无瘤分为三组进行比较。主要终点是90天死亡率。次要终点是对 ICU 管理、ARDS 病因和死亡风险因素的描述。其中990人患有HM,2744人患有实体瘤。主要恶性肿瘤为非霍奇金淋巴瘤(NHL)(28.5%)、急性髓性白血病(AML)(20.4%)和多发性骨髓瘤(19.7%)。HM患者的第90天死亡率高于非癌症患者(64.4%对46.6%,P = 0.01),但与实体瘤患者(64.4%对61.4%,P = 0.09)的死亡率没有差异。与两组患者相比,HM 患者的插管率较低(实体癌患者为 87.7% 对 90.4%,p = 0.02;非癌症患者为 87.7% 对 91.3%;p < 0.01)。HM患者死亡率的独立预测因素包括淋巴瘤或急性白血病诊断、年龄、改良SAPS II评分高、肾脏替代治疗、侵袭性真菌感染和脓毒性休克。细菌性肺炎、肺外感染和无创通气具有保护作用。这一人群的死亡率预测因素包括淋巴瘤或急性白血病诊断、年龄、改良 SAPS II 评分高、肾脏替代治疗、侵袭性真菌感染和脓毒性休克。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Acute respiratory distress syndrome in patients with hematological malignancies: a one-year retrospective nationwide cohort study

Acute respiratory distress syndrome in patients with hematological malignancies: a one-year retrospective nationwide cohort study

Background

Acute respiratory distress syndrome (ARDS) occurring in patients with hematological malignancies (HM) is a life-threatening condition with specific features. Mortality rate remains high but improvement has been described over the past several years. We aimed to describe characteristics and outcomes of ARDS in HM patients admitted in French ICUs (Intensive Care Units) during a one year-period. Data for this nationwide cohort study were collected from the French national hospital database (Programme de Médicalisation des Systèmes d’Information (PMSI)). All patients (18 years or older) admitted to French ICUs in 2017 and with a diagnosis of ARDS were included. Three groups were compared according to the presence of an HM, a solid cancer or no cancer. The primary endpoint was 90-day mortality. Secondary endpoints were the description of ICU management, etiologies of ARDS and mortality risk factors.

Results

A total of 12 846 patients with ARDS were included. Among them, 990 had HM and 2744 had a solid cancer. The main malignancies were non-Hodgkin lymphoma (NHL) (28.5%), acute myeloid leukemia (AML) (20.4%) and multiple myeloma (19.7%). Day-90 mortality in patients with HM was higher than in patients with no cancer (64.4% vs. 46.6% p = 0.01) but was not different from that of patients with solid cancer (64.4% vs. 61.4%,p = 0.09). Intubation rate was lower in patients with HM in comparison with both groups (87.7% vs. 90.4% p = 0.02 for patients with solid cancer and 87.7% vs. 91.3%; p < 0.01 with no cancer). Independent predictors of mortality for patients with HM were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection, and a septic shock. Bacterial pneumonia, extrapulmonary infections and non-invasive ventilation were protective.

Conclusion

Mortality remains high in patients with HM admitted in ICU with ARDS in comparison with patients without cancer. Mortality predictors for this population were a diagnosis of lymphoma or acute leukemia, age, a high modified SAPS II score, a renal replacement therapy, invasive fungal infection and a septic shock.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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