扩散性恶性肿瘤患者在非计划性ICU逗留后返家情况的临床观察性多中心回顾性研究。
Critically ill metastatic cancer patients returning home after unplanned ICU stay: an observational, multicentre retrospective study.
发表日期：2023 Aug 21
作者：
Frédéric Gonzalez, Rémi Starka, Laurent Ducros, Magali Bisbal, Laurent Chow-Chine, Luca Servan, Jean-Manuel de Guibert, Bruno Pastene, Marion Faucher, Antoine Sannini, Marc Leone, Djamel Mokart
来源：
Annals of Intensive Care
摘要：
大病危转移癌患者因突发情况入住重症监护病房（ICU）的功能恢复情况的数据很少。本研究的目的是评估与此人群90天回家和1年生存率相关的因素。一项多中心回顾性研究包括了2017年至2020年期间所有连续入住ICU的转移癌患者。在包括253名转移癌患者中，主要是肺癌，有94名患者（37.2%）在90天内能够回家。1年生存率为28.5%。术后卧床或行动自如的状况为0或1级（OR，2.18；95% CI 1.21-3.93；P = 0.010）、无营养不良（OR，2.90；95% CI 1.61-5.24；P < 0.001）、女性（OR，2.39；95% CI 1.33-4.29；P = 0.004）、最近化疗（OR，2.62；95% CI 1.40-4.90；P = 0.003）、入住时的SOFA评分≤5（OR，2.62；95% CI 1.41-4.90；P = 0.002）这些因素在90天回家的预测中具有显著性。营养不良（HR，1.66；95% CI 1.18-2.22；P = 0.003）、急性呼吸衰竭（ARF）作为入院原因（HR，1.40；95% CI 1.10-1.95；P = 0.043）、入住时的SAPS II评分（HR，1.03；95% CI 1.02-1.05；P < 0.001）和决定放弃维持生命治疗（DFLST）（HR，2.80；95% CI 2.04-3.84；P < 0.001）与1年死亡率独立相关。超过三分之一的转移癌患者在入住ICU后的3个月内能够回家。先前的病情和营养状况、持续的特定治疗和急性疾病的严重程度较低是回家的预测因素。这些鼓舞人心的发现应该有助于改变对病危转移癌患者的黯淡观念。© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).
Data about critically ill metastatic cancer patients functional outcome after unplanned admission to the ICU are scarce. The aim of this study was to assess factors associated with 90-day return home and 1-year survival in this population.A multicenter retrospective study included all consecutive metastatic cancer patients admitted to the ICU for unplanned reason between 2017 and 2020.Among 253 included metastatic cancer patients, mainly with lung cancer, 94 patients (37.2%) could return home on day 90. One-year survival rate was 28.5%. Performance status 0 or 1 (OR, 2.18; 95% CI 1.21-3.93; P = 0.010), no malnutrition (OR, 2.90; 95% CI 1.61-5.24; P < 0.001), female gender (OR, 2.39; 95% CI 1.33-4.29; P = 0.004), recent chemotherapy (OR, 2.62; 95% CI 1.40-4.90; P = 0.003), SOFA score ≤ 5 on admission (OR, 2.62; 95% CI 1.41-4.90; P = 0.002) were significantly predictive for 90-day return home. Malnutrition (HR, 1.66; 95% CI 1.18-2.22; P = 0.003), acute respiratory failure (ARF) as reason for admission (HR, 1.40; 95% CI 1.10-1.95; P = 0.043), SAPS II on admission (HR, 1.03; 95% CI 1.02-1.05; P < 0.001) and decisions to forgo life-sustaining therapies (DFLST) (HR, 2.80; 95% CI 2.04-3.84; P < 0.001) were independently associated with 1-year mortality.More than one out of three metastatic cancer patients could return home within 3 months after an unplanned admission to the ICU. Previous performance and nutritional status, ongoing specific treatment and low severity of the acute illness were found to be predictive for return home. Such encouraging findings should help change the dismal perception of critically ill metastatic cancer patients.© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).