严重的免疫检查点抑制剂(ICI)相关的神经毒性很少见。关于重症监护病房(ICU)收治的严重神经系统免疫相关不良事件(NirAEs)患者的护理细节和结果的数据有限。
对2016年1月至2018年12月在3个学术中心入住ICU的严重NirAE患者进行回顾性研究。收集的临床数据包括ICI暴露,NirAE(中枢[CNS]或外周神经系统[PNS)疾病)的类型,和患者预后,包括神经系统恢复和死亡率。
17例患者出现严重NirAE。8例PNS患者;6例重症肌无力(MG),1例合并MG和多发性神经病,1例合并格林-巴利综合征。9例患者患有中枢神经系统疾病(6例癫痫发作,5例并发脑病。入住ICU期间,65%的患者需要机械通气,35%的血管升压药,和18%的肾脏替代疗法。ICU和住院时间中位数分别为7(2-36)和18(4-80)天,分别。医院死亡率为29%。出院时,18%的患者神经完全恢复,41%的部分回收率,12%没有恢复。
严重的NirAE虽然不常见,如果不及早诊断和治疗,可能会严重甚至危及生命。
Serious immune checkpoint inhibitor (ICI)-related neurotoxicity is rare. There is limited data on the specifics of care and outcomes of patients with severe neurological immune related adverse events (NirAEs) admitted to the Intensive Care Unit (ICU).
Retrospective study of patients with severe NirAEs admitted to the ICU at 3 academic centers between January 2016 and December 2018. Clinical data collected included ICI exposure, type of NirAE (central [CNS] or peripheral nervous system [PNS) disorders), and patient outcomes including neurological recovery and mortality.
Seventeen patients developed severe NirAEs. Eight patients presented with PNS disorders; 6 with myasthenia gravis (MG), 1 had a combination of MG and polyneuropathy and 1 had Guillain-Barre syndrome. Nine patients had CNS disorders (6 seizures and 5 had concomitant encephalopathy. During ICU admission, 65% of patients required mechanical ventilation, 35% vasopressors, and 18% renal replacement therapy. The median ICU and hospital length of stay were 7 (2-36) and 18 (4-80) days, respectively. Hospital mortality was 29%. At hospital discharge, 18% of patients made a full neurologic recovery, 41% partial recovery, and 12% did not recover.
Severe NirAEs while uncommon, can be serious or even life-threatening if not diagnosed and treated early.