背景技术嵌合抗原受体T细胞(CAR-T)疗法已经成为用于各种恶性肿瘤的有希望的免疫疗法。然而,它的使用与挑战有关,包括细胞因子释放综合征(CRS),潜在的严重并发症.这项回顾性研究旨在分析风险,结果,以及接受CAR-T治疗的患者CRS的医疗负担。方法利用来自2020年全国住院患者样本(NIS)的数据,包括415个与CAR-T相关的住院治疗。它们被分为有CRS的(n=68)和没有CRS的(n=347)。基线特征,包括年龄,性别,种族,收入,保险状况,和合并症,进行了比较。感兴趣的结果包括住院死亡率,停留时间(LOS)医院总费用,以及并发症的发生,协会,和干预。统计分析,包括多变量模型,被用来评估协会。结果CRS住院患者的年龄没有显着差异,性别,种族,收入,或与没有CRS的保险状况相比。多变量分析显示死亡率无统计学差异(调整比值比(aOR)=2.48,95%置信区间(CI):0.71至8.69,p=0.151),LOS(系数=-2.1天,95%CI:-5.43至1.21,p=0.207),或两组之间的总住院费用(系数=$207,456,95%CI:$6119至$421,031,p=0.057)。CRS组发热发生率较高(aOR=1.91,95%CI:1.15~3.17,p=0.014),急性呼吸衰竭(aOR=2.10,95%CI:1.01至4.40,p=0.049),和需要插管/机械通气(aOR=2.59,95%CI:1.14至5.88,p=0.024)。噬血细胞淋巴组织细胞增多症(HLH)与CRS显著相关(aOR=6.72,95%CI:2.03~22.18,p=0.002)。结论虽然在CAR-T治疗的患者中CRS的发展并没有显著增加死亡率,LOS,或者医院的全部费用,它与特定的风险和结果有关,包括发烧,呼吸衰竭,和HLH。这项研究强调了在CAR-T治疗中识别和管理CRS以优化患者预后的重要性。这些发现有助于指导CAR-T治疗背景下的临床决策。
Background Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising immunotherapy for various malignancies. However, its use is associated with challenges, including cytokine release syndrome (CRS), a potentially severe complication. This retrospective
study aims to analyze the risks, outcomes, and healthcare burden of CRS in patients undergoing CAR-T therapy. Method Data from the 2020 National Inpatient Sample (NIS) were utilized, comprising 415 CAR-T-related hospitalizations. They were categorized into those with CRS (n = 68) and those without CRS (n = 347). Baseline characteristics, including age, gender, race, income, insurance status, and comorbidities, were compared. Outcomes of interest included in-hospital mortality, length of stay (LOS), total hospital charges, and access to complications, associations, and interventions. Statistical analyses, including multivariable models, were employed to assess associations. Results Hospitalizations with CRS did not exhibit significant differences in age, gender, race, income, or insurance status compared to those without CRS. The multivariable analysis showed no statistically significant difference in mortality (adjusted odds ratio (aOR) = 2.48, 95% confidence interval (CI): 0.71 to 8.69, p = 0.151), LOS (coefficient = -2.1 days, 95% CI: -5.43 to 1.21, p = 0.207), or total hospital charges (coefficient = $207,456, 95% CI: $6119 to $421,031, p = 0.057) between the two groups. The CRS group had a higher incidence of fever (aOR = 1.91, 95% CI: 1.15 to 3.17, p = 0.014), acute respiratory failure (aOR = 2.10, 95% CI: 1.01 to 4.40, p= 0.049), and the need for intubation/mechanical ventilation (aOR = 2.59, 95% CI: 1.14 to 5.88, p = 0.024). Hemophagocytic lymphohistiocytosis (HLH) was significantly associated with CRS (aOR = 6.72, 95% CI: 2.03 to 22.18, p = 0.002). Conclusion While the development of CRS in CAR-T-treated patients did not significantly increase mortality, LOS, or total hospital charges, it was associated with specific risks and outcomes, including fever, respiratory failure, and HLH. This
study emphasizes the importance of vigilance in recognizing and managing CRS in CAR-T therapy to optimize patient outcomes. The findings contribute valuable insights to guide clinical decision-making in the context of CAR-T therapy.