Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2025-06-01 Epub Date: 2025-01-22 DOI:10.1016/j.jcrc.2025.155028

Mickael Lescroart , Hélène Kemp , Olivier Imauven , Jean Herlé Raphalen , François Bagate , Julien Schmidt , Nahema Issa , Maxens Decavele , Anne-Sophie Moreau , Fabienne Tamion , Bruno Mourvillier , Laure Calvet , Emmanuel Canet , Christine Lebert , Stephanie Pons , Guillaume Lacave , Florent Wallet , Hadrien Winiszewski , Hamid Merdji , Marc Pineton De Chambrun , Lara Zafrani

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Abstract

Purpose

Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs).

Methods

This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010−2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients.

Results

The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54).

Conclusion

The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.

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活动性肿瘤-血液系统恶性肿瘤患者的心源性休克：一项多中心回顾性研究。

目的：肿瘤血液学（OH）患者由于恶性肿瘤和药物毒性而面临显著的心血管风险。重症监护病房（icu） OH合并心源性休克（CS）患者的特征和预后数据有限。方法：这项多中心回顾性研究纳入了22个icu（2010-2021）的214例OH合并CS患者。目的是(i)确定30天死亡率的危险因素，（ii）描述早期和长期结果，以及（iii）通过比较OH患者和对照组CS患者来评估恶性肿瘤的预后影响。结果：30天生存率为44.8%。多因素分析发现，既往心肌病（OR = 1.61）、急性肾损伤（OR = 1.62）、乳酸水平（OR = 1.08 / 1mmol /L）、肺栓塞（OR = 3.04）、有创机械通气（OR = 3.48）和肾上腺素使用（OR = 2.09）是与30天死亡率相关的因素。在ICU幸存者中，54%的人在1年时存活，中位左心室射血分数为52%。OH恶性肿瘤与30天死亡率显著相关（HR 2.54）。结论：OH合并CS患者在ICU的预后较差，肾上腺素的使用与预后较差相关。需要进一步的研究来完善风险分层和改善对这一人群的治疗。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.