癌症患者的出血事件:前瞻性队列研究中的发生率、危险因素及其对预后的影响。
Bleeding events in patients with cancer: incidence, risk factors, and impact on prognosis in a prospective cohort study.
发表日期:2024 Aug 27
作者:
Cornelia Englisch, Florian Moik, Daniel Steiner, Angelika M Starzer, Anna Sophie Berghoff, Matthias Preusser, Ingrid Pabinger, Cihan Ay
来源:
BLOOD
摘要:
癌症患者经常出现血液失衡。虽然癌症相关的血栓并发症已得到很好的表征,但癌症患者出血事件的数据却很少。因此,我们旨在通过前瞻性队列研究维也纳癌症、血栓形成和出血研究 (CAT-BLED) 调查开始全身抗癌治疗的癌症患者出血事件的发生率、危险因素及其对预后的影响。主要研究结果定义为临床相关出血(CRB),包括大出血(MB)和临床相关非大出血(CRNMB)。总共包括 791 名患有各种癌症类型的患者(48% 为女性,中位年龄 [四分位距,IQR]:63 [54-70] 岁),其中 65.5% 为 IV 期。在中位随访 19 个月(IQR:8.7-24.0)中,我们观察到 139 名(17.6%)名患者发生了 194 起 CRB 事件,其中 42 名(30%)与肿瘤相关,64 名(46.0%)与胃肠道相关, 7 (5.0%) 脑内。整个队列中首次 CRB 和 MB 的 12 个月累积发生率为 16.6%(95% 置信区间 [CI]:13.7-19.6)和 9.1%(95% CI:6.8-11.3),14.4%(95% 置信区间 [CI]:6.8-11.3)。未接受抗凝治疗的患者的区间 [CI]:11.2-17.5)和 7.0%(95% CI:4.7-9.2)。头颈癌患者发生 CRB 的风险最高。较低的基线血红蛋白和白蛋白与未抗凝患者的出血相关。 7 例 (5.0%) 出血事件是致命的,其中 6 例发生在未接受抗凝治疗的患者中。 CRB 患者的全因死亡风险增加(多变量转变风险比 [95%CI]:5.80 [4.53-7.43])。在癌症患者中,出血事件是一种常见的并发症,并与死亡率增加相关。版权所有 © 2024 美国血液学会。
Hemostatic imbalances are frequent in patients with cancer. While cancer-associated thrombotic complications have been well characterized, data on bleeding events in cancer patients are sparse. Therefore, we aimed to investigate the incidence, risk factors, and impact on prognosis of bleeding events in cancer patients initiating systemic anti-cancer therapies in a prospective cohort study, the Vienna Cancer, Thrombosis and Bleeding Study (CAT-BLED). The primary study outcome was defined as clinically relevant bleeding (CRB), comprising major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). In total, 791 patients (48% female, median age [interquartile range, IQR]: 63 [54-70] years) with various cancer types, 65.5% stage IV, were included. Over a median follow-up of 19 months (IQR: 8.7-24.0), we observed 194 CRB events in 139 (17.6%) patients, of which 42 (30%) were tumor-related, 64 (46.0%) gastrointestinal, and 7 (5.0%) intracerebral. The 12-month cumulative incidence of first CRB and MB was 16.6% (95% confidence interval [CI]: 13.7-19.6) and 9.1% (95% CI: 6.8-11.3) in the whole cohort and 14.4% (95% confidence interval [CI]: 11.2-17.5) and 7.0% (95% CI: 4.7-9.2) in those without anticoagulation. Patients with head and neck cancer had the highest risk of CRB. Lower baseline hemoglobin and albumin were associated with bleeding in patients without anticoagulation. Seven (5.0%) bleeding events were fatal, of which 6 occurred in patients without anticoagulation. Patients with CRB were at an increased risk of all-cause mortality (multivariable transition hazard ratio [95%CI]: 5.80 [4.53-7.43]). In patients with cancer bleeding events represent a frequent complication and are associated with increased mortality.Copyright © 2024 American Society of Hematology.