PDF(Pubmed)
Abstract：
UNASSIGNED: Neutropenic sepsis frequently requires admission to an intensive care unit (ICU). Differences between subgroups of patients with neutropenic sepsis are not well characterized.
UNASSIGNED: To investigate clinical outcomes among patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis.
UNASSIGNED: Retrospective cohort study of all patients admitted to ICU in Australia or New Zealand between January 2000 and December 2022 with a primary admission diagnosis of sepsis and total white cell count <1.0 × 109 cells/L.
UNASSIGNED: We identified 8617 ICU admissions with neutropenic sepsis (hematological malignancy n = 4660; metastatic solid cancer n = 1034; no cancer n = 2800). Patients with hematological malignancy were younger (median, 61.5 years) with low rates of chronic comorbidities (4.7%) and were usually admitted to ICU from the ward (67.4%). Mechanical ventilation rates were 20.2% and in-hospital mortality was 30.6%. Patients with metastatic solid cancers were older (median, 66.3 years), with higher rates of chronic comorbidities (9.9%), and were usually admitted to the ICU from the emergency department (50.8%). Mechanical ventilation rates were 16.9% and in-hospital mortality was 42.4%. Patients with no documented cancer had highest rates of mechanical ventilation (41.7%) and mortality (46.3%). Neutropenia was independently associated with mortality among patients with solid cancers or no cancer but did not confer increased risk among patients with hematological malignancy (odds ratio, 0.98; 95% confidence interval, .90-1.06; P = .60).
UNASSIGNED: Patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis constitute 3 distinct clinical groups. Management approaches should be tailored accordingly.
UNASSIGNED: To investigate clinical outcomes among patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis.
UNASSIGNED: Retrospective cohort study of all patients admitted to ICU in Australia or New Zealand between January 2000 and December 2022 with a primary admission diagnosis of sepsis and total white cell count <1.0 × 109 cells/L.
UNASSIGNED: We identified 8617 ICU admissions with neutropenic sepsis (hematological malignancy n = 4660; metastatic solid cancer n = 1034; no cancer n = 2800). Patients with hematological malignancy were younger (median, 61.5 years) with low rates of chronic comorbidities (4.7%) and were usually admitted to ICU from the ward (67.4%). Mechanical ventilation rates were 20.2% and in-hospital mortality was 30.6%. Patients with metastatic solid cancers were older (median, 66.3 years), with higher rates of chronic comorbidities (9.9%), and were usually admitted to the ICU from the emergency department (50.8%). Mechanical ventilation rates were 16.9% and in-hospital mortality was 42.4%. Patients with no documented cancer had highest rates of mechanical ventilation (41.7%) and mortality (46.3%). Neutropenia was independently associated with mortality among patients with solid cancers or no cancer but did not confer increased risk among patients with hematological malignancy (odds ratio, 0.98; 95% confidence interval, .90-1.06; P = .60).
UNASSIGNED: Patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis constitute 3 distinct clinical groups. Management approaches should be tailored accordingly.
摘要：
■中性粒细胞减少性败血症经常需要进入重症监护病房（ICU）。中性粒细胞减少性败血症患者亚组之间的差异未得到很好的表征。
■为了研究中性粒细胞减少性败血症和恶性血液病患者的临床结局，转移性实体癌,或者没有癌症诊断。
■对2000年1月至2022年12月在澳大利亚或新西兰入住ICU的所有患者进行回顾性队列研究，这些患者的主要入院诊断为败血症，总白细胞计数<1.0×109细胞/L。
■我们确定了8617例中性粒细胞减少性败血症的ICU入院（血液恶性肿瘤n=4660；转移性实体癌n=1034；无癌n=2800）。恶性血液病患者较年轻（中位数，61.5年），慢性合并症发生率低（4.7％），通常从病房进入ICU（67.4％）。机械通气率为20.2%，院内死亡率为30.6%。转移性实体癌患者年龄较大（中位数，66.3年)，慢性合并症发生率较高(9.9%)，通常从急诊科进入ICU(50.8%)。机械通气率为16.9%，院内死亡率为42.4%。没有癌症记录的患者机械通气率（41.7%）和死亡率（46.3%）最高。中性粒细胞减少与实体癌患者或无癌症患者的死亡率独立相关，但并不增加血液系统恶性肿瘤患者的风险（比值比，0.98；95%置信区间，.90-1.06；P=.60）。
■中性粒细胞减少性败血症和血液系统恶性肿瘤患者，转移性实体癌,或无癌症诊断构成3个不同的临床组。管理方法应相应调整。
■为了研究中性粒细胞减少性败血症和恶性血液病患者的临床结局，转移性实体癌,或者没有癌症诊断。
■对2000年1月至2022年12月在澳大利亚或新西兰入住ICU的所有患者进行回顾性队列研究，这些患者的主要入院诊断为败血症，总白细胞计数<1.0×109细胞/L。
■我们确定了8617例中性粒细胞减少性败血症的ICU入院（血液恶性肿瘤n=4660；转移性实体癌n=1034；无癌n=2800）。恶性血液病患者较年轻（中位数，61.5年），慢性合并症发生率低（4.7％），通常从病房进入ICU（67.4％）。机械通气率为20.2%，院内死亡率为30.6%。转移性实体癌患者年龄较大（中位数，66.3年)，慢性合并症发生率较高(9.9%)，通常从急诊科进入ICU(50.8%)。机械通气率为16.9%，院内死亡率为42.4%。没有癌症记录的患者机械通气率（41.7%）和死亡率（46.3%）最高。中性粒细胞减少与实体癌患者或无癌症患者的死亡率独立相关，但并不增加血液系统恶性肿瘤患者的风险（比值比，0.98；95%置信区间，.90-1.06；P=.60）。
■中性粒细胞减少性败血症和血液系统恶性肿瘤患者，转移性实体癌,或无癌症诊断构成3个不同的临床组。管理方法应相应调整。
