September 2018
Abstract
Importance 背景
Within the surgical population admitted to intensive care units (ICUs), cancer is a common condition. However, clinicians can be reluctant to admit patients with cancer to ICUs owing to concerns about survival.
在收入ICU的外科患者中，肿瘤非常普遍。然而，临床医生可能由于存活率的顾虑不愿意将肿瘤患者收入ICU。
Objective 目的
To compare the clinical characteristics and outcomes of surgical patients with and without cancer who are admitted to ICUs.
比较收入ICU的肿瘤与非肿瘤外科患者的临床特征及预后。
Design, Setting, and Participants 设计、场景及研究人群
An observational retrospective cohort study using ICU audit records linked to hospitalization discharge summaries, cancer registrations, and death records of all 16 general adult ICUs in the West of Scotland was conducted. All 25 017 surgical ICU admissions between January 1, 2000, and December 31, 2011, were included, and data analysis was conducted during that time.
我们在苏格兰西部的16个成人综合性ICU中进行了一项观察性回顾性队列研究，将ICU收治患者记录与出院诊断、肿瘤登记和死亡记录相联系。我们纳入了2000年1月1日至2011年12月31日收入ICU的所有25017名外科患者。
Exposures 暴露因素
Patients were dichotomized based on a diagnosis of a solid malignant tumor as determined by its documentation in the Scottish Cancer Registry within the 2 years prior to ICU admission.
根据在收入ICU前2年内苏格兰肿瘤登记记录中有关实体恶性肿瘤的诊断，将患者分为2组。
Main Outcomes and Measures 主要预后指标
Intensive care unit patients with cancer were compared with ICU patients without cancer in terms of patient characteristics (age, sex, severity of illness, reason for admission, and organ support) and survival (ICU, hospital, 6 months, and 4 years).
将罹患肿瘤的ICU患者与非肿瘤患者进行比较，包括患者特征（年龄，性别，疾病严重程度，入ICU原因及器官支持）和存活情况（ICU，住院，6个月及4年）。
Results 结果
Within the 25 017 surgical ICU patients, 13 684 (54.7%) were male, the median (interquartile range [IQR]) age was 64 (50-74), and 5462 (21.8%) had an underlying solid tumor diagnosis. Patients with cancer were older (median [IQR] age, 68 [60-76] vs 62 [45-74] years; P < .001) with a higher proportion of elective hospitalizations (60.5% vs 19.8%; P < .001), similar Acute Physiology and Chronic Health Evaluation II scores (median for both, 17), but lower use of multiorgan support (57.9% vs 66.7%; P < .001). Intensive care unit and hospital mortality were lower for the cancer group, at 12.2% (95% CI, 11.3%-13.1%) vs 16.8% (95% CI, 16.3%-17.4%) (P < .001) and 22.9% (95% CI, 21.8%-24.1%) vs 28.1% (27.4%-28.7%) (P < .001). Patients with cancer had an adjusted odds ratio for hospital mortality of 1.09 (95% CI, 1.00-1.19). By 6 months, mortality in the cancer group was higher than that in the noncancer group at 31.3% compared with 28.2% (P < .001). Four years after ICU admission, mortality for those with and without cancer was 60.9% vs 39.7% (P < .001) respectively.
在25 017名收入ICU的外科患者中，13 684名 (54.7% )为男性，中位（四分位区间 [IQR]）64 岁 (50-74)，5462名(21.8%) 患者基础诊断为实体肿瘤。肿瘤患者年龄更大（中位 [IQR] 年龄，68 [60-76] vs 62 [45-74] 岁；P < .001），择期住院比例更高 (60.5% vs 19.8%; P < .001)，APACHE II评分相似（两组中位分数 17），但多器官支持治疗比例较低 (57.9% vs 66.7%; P < .001)。肿瘤患者组ICU及住院病死率较非肿瘤组患者低，分别为 12.2% (95% CI, 11.3%-13.1%) vs 16.8% (95% CI, 16.3%-17.4%) (P < .001) 和 22.9% (95% CI, 21.8%-24.1%) vs 28.1% (27.4%-28.7%) (P < .001)。肿瘤患者住院病死率校正比数比为 1.09 (95% CI, 1.00-1.19)。6个月时，肿瘤组患者病死率高于非肿瘤组患者 (31.3% vs. 28.2%, P < .001)。ICU住院后4年时，肿瘤与非肿瘤患者病死率分别为 60.9% vs 39.7% (P < .001)。
Conclusions and Relevance 结论与意义
Cancer is a common diagnosis among surgical ICU patients and this study suggests that initial outcomes compare favorably with those of ICU patients with other conditions. Consideration that a diagnosis of cancer should not preclude admission to the ICU in patients with surgical disease is suggested.
肿瘤是外科ICU患者的常见诊断，研究表明，肿瘤患者初始预后与其他ICU患者相似。提示肿瘤诊断不应妨碍患者收入ICU。
