背景:血液学家每天都在处理急性白血病患者的高死亡率。很多时候,这些患者需要重症监护病房(ICU)的支持,一些一般的ICU团队认为,这些患者比其他疾病患者死亡的机会更大。在巴西,与急性白血病患者死亡率和ICU相关的数据很少.
方法:因此,评估急性白血病患者入住专门的血液ICU的死亡率预测因子,我们评估了人口统计学,支持性护理,住院时间,疾病状态,承认诊断,中性粒细胞减少症,输血次数和急性生理和慢性健康评估(APACHE)/脓毒症相关器官衰竭评估(SOFA)评分可能与死亡率相关。数据是从2006年至2009年期间入住伯南布哥州Hemocentro(Hemope)ICU的110例急性白血病患者的首次入院记录中提取的。
结果:在这项回顾性队列研究中,72/110的患者是男性,64/110来自累西腓大都市区。患者年龄中位数为43.5岁(±17.9);67.3%患有急性髓性白血病(AML),32.7%患有急性淋巴样白血病。ICU的主要入院诊断为败血症(66.7%)。APACHEII平均得分为18.3分。在总数中,65(59%)死亡,死亡率与住院时间长短独立相关(p<0.001),APACHEII评分增加(p<0.038)和接受血液透析(p<0.006)。中性粒细胞减少症,入院时接受多次输血和使用任何类型的机械通气或血管活性药物与死亡率无关.与较高死亡率相关的因素是:住院时间较长,APACHEII评分增加,和使用血液透析。
结论:有了这些数据,在进入ICU之前防止器官损伤,更好的策略可能是降低白血病患者的死亡率.
BACKGROUND: Hematologists deal every day with high mortality rates of acute leukemia patients. Many times these patients need Intensive Care Unit (ICU) support and some general ICU teams believe that these patients have a much greater chance of dying than patients with other pathologies. In Brazil, data related to mortality rates and ICUs for acute leukemia patients are scarce.
METHODS: Therefore, to assess mortality predictors in patients with acute leukemia admitted to a specialized hematological ICU, we evaluated demographics, supportive care, hospitalization time, disease status, admitting diagnosis, neutropenia, number of transfusions and Acute Physiology and Chronic Health Evaluation (APACHE)/Sepsis Related Organ Failure Assessment (SOFA) scores as possible factors associated with mortality. Data were extracted from the first admission records of 110 patients with acute leukemia admitted to the Hemocentro de Pernambuco (Hemope) ICU between 2006 and 2009.
RESULTS: In this retrospective cohort study, 72/110 of the patients were men, and 64/110 were from the metropolitan area of Recife. The patients\' age median was 43.5 years (±17.9); 67.3% had acute myeloid leukemia (AML) and 32.7% had acute lymphoid leukemia. The main admitting diagnosis in the ICU was sepsis (66.7%). The mean APACHE II score was 18.3. Of the total, 65 (59%) died, and the mortality rate was independently related to longer hospitalization (p<0.001), the increase in the APACHE II score (p<0.038) and having received hemodialysis (p<0.006). Neutropenia, receiving multiple transfusions and using any kind of mechanical ventilation or vasoactive drug on admission were not relevant to mortality. Factors associated with higher mortality rates were: longer hospitalization, increase in the APACHE II score, and use of hemodialysis.
CONCLUSIONS: With these data, to prevent organ lesions before admission to the ICU, a better strategy might be to reduce mortality for leukemia patients.