Abstract：
BACKGROUND: Programmed cell death 1 (PD-1) inhibitors can induce various adverse reactions associated with immunity, of which cardiotoxicity is a serious complication. Limited research exists on the link between PD-1 inhibitor use and pericardial effusion (PE) occurrence and outcomes.
METHODS: We conducted a retrospective study at the First Affiliated Hospital of Xi\'an Jiaotong University from 2017 to 2019, comparing cancer patients who developed PE within 2 years after PD-1 inhibitor therapy to those who did not. Our primary outcome was the all-cause mortality rate at one year. We applied the Kaplan-Meier method for survival analysis. Multivariate logistic regression was utilized to identify PE risk factors, adjusting for potential confounders.
RESULTS: A total of 91 patients were finally included, of whom 39 patients had PE. Compared to non-PE group, one-year all-cause mortality was nearly 5 times higher in PE group (64.10% vs. 13.46%, P < 0.001). Patients who developed PE within 2 years of taking PD-1 inhibitors were significantly associated with increased all-cause mortality compared with those who did not (HR: 6.26, 95%CI: 2.70-14.53, P < 0.001). Multivariable logistic regression showed that use of sintilimab (OR: 14.568, 95%CI: 3.431-61.857, P < 0.001), history of lung cancer (OR: 15.360, 95%CI: 3.276-72.017, P = 0.001), and history of hypocalcemia (OR: 7.076, 95%CI: 1.879-26.649, P = 0.004) were independent risk factors of PE development in patients received PD-1 inhibitors therapy.
CONCLUSIONS: In cancer patients receiving PD-1 inhibitors, PE was associated with higher one-year mortality. Use of sintilimab, and history of lung cancer or hypocalcemia were linked to PE occurrence.
METHODS: We conducted a retrospective study at the First Affiliated Hospital of Xi\'an Jiaotong University from 2017 to 2019, comparing cancer patients who developed PE within 2 years after PD-1 inhibitor therapy to those who did not. Our primary outcome was the all-cause mortality rate at one year. We applied the Kaplan-Meier method for survival analysis. Multivariate logistic regression was utilized to identify PE risk factors, adjusting for potential confounders.
RESULTS: A total of 91 patients were finally included, of whom 39 patients had PE. Compared to non-PE group, one-year all-cause mortality was nearly 5 times higher in PE group (64.10% vs. 13.46%, P < 0.001). Patients who developed PE within 2 years of taking PD-1 inhibitors were significantly associated with increased all-cause mortality compared with those who did not (HR: 6.26, 95%CI: 2.70-14.53, P < 0.001). Multivariable logistic regression showed that use of sintilimab (OR: 14.568, 95%CI: 3.431-61.857, P < 0.001), history of lung cancer (OR: 15.360, 95%CI: 3.276-72.017, P = 0.001), and history of hypocalcemia (OR: 7.076, 95%CI: 1.879-26.649, P = 0.004) were independent risk factors of PE development in patients received PD-1 inhibitors therapy.
CONCLUSIONS: In cancer patients receiving PD-1 inhibitors, PE was associated with higher one-year mortality. Use of sintilimab, and history of lung cancer or hypocalcemia were linked to PE occurrence.
摘要：
背景：程序性细胞死亡1（PD-1）抑制剂可诱导与免疫相关的各种不良反应，其中心脏毒性是严重的并发症。关于PD-1抑制剂使用与心包积液（PE）发生和结果之间的联系的研究有限。
方法：我们于2017年至2019年在西安交通大学第一附属医院进行了一项回顾性研究，比较了PD-1抑制剂治疗后2年内发生PE的癌症患者与未发生PE的癌症患者。我们的主要结果是一年的全因死亡率。我们应用Kaplan-Meier方法进行生存分析。多因素logistic回归用于确定PE危险因素，调整潜在的混杂因素。
结果：最终共纳入91例患者，其中39例患者患有PE。与非PE组相比，PE组一年全因死亡率高出近5倍(64.10%vs.13.46%,P<0.001)。与未服用PD-1抑制剂的患者相比，在服用PD-1抑制剂的2年内发生PE的患者与全因死亡率增加显着相关（HR：6.26，95CI：2.70-14.53，P<0.001）。多因素logistic回归分析显示,使用辛替利玛(OR:14.568,95CI:3.431~61.857,P<0.001),肺癌病史（OR：15.360，95CI：3.276-72.017，P=0.001），低钙血症史(OR:7.076,95CI:1.879~26.649,P=0.004)是PD-1抑制剂治疗患者发生PE的独立危险因素。
结论：使用PD-1抑制剂会增加癌症患者的PE风险，尤其是肺癌和低钙血症患者,并且与PE患者一年死亡率较高有关。
方法：我们于2017年至2019年在西安交通大学第一附属医院进行了一项回顾性研究，比较了PD-1抑制剂治疗后2年内发生PE的癌症患者与未发生PE的癌症患者。我们的主要结果是一年的全因死亡率。我们应用Kaplan-Meier方法进行生存分析。多因素logistic回归用于确定PE危险因素，调整潜在的混杂因素。
结果：最终共纳入91例患者，其中39例患者患有PE。与非PE组相比，PE组一年全因死亡率高出近5倍(64.10%vs.13.46%,P<0.001)。与未服用PD-1抑制剂的患者相比，在服用PD-1抑制剂的2年内发生PE的患者与全因死亡率增加显着相关（HR：6.26，95CI：2.70-14.53，P<0.001）。多因素logistic回归分析显示,使用辛替利玛(OR:14.568,95CI:3.431~61.857,P<0.001),肺癌病史（OR：15.360，95CI：3.276-72.017，P=0.001），低钙血症史(OR:7.076,95CI:1.879~26.649,P=0.004)是PD-1抑制剂治疗患者发生PE的独立危险因素。
结论：使用PD-1抑制剂会增加癌症患者的PE风险，尤其是肺癌和低钙血症患者,并且与PE患者一年死亡率较高有关。
