Dara Chean, David Luque-Paz, Daniele Poole, Sofiane Fodil, Etienne Lengliné, Thibault Dupont, Achille Kouatchet, Michael Darmon, Élie Azoulay
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引用次数: 0
摘要
背景：描述重症监护病房（ICU）急性白血病患者生命维持疗法的使用和死亡率。方法：检索PubMed数据库2000年1月1日至2023年7月1日。所有涉及急性白血病成人危重患者的研究均被纳入。两名审稿人独立选择研究，使用纽卡斯尔-渥太华量表评估队列研究的偏倚，并从全文阅读中提取数据。我们使用随机效应模型进行了比例荟萃分析。主要终点为ICU全因死亡率。次要结局包括ICU入院原因、器官支持治疗（机械通气、血管加压剂和肾脏替代治疗）的使用、住院、第90天死亡率和1年死亡率。结果：在筛选的1,331项研究中，136项（24,861例患者）符合纳入标准并被纳入meta分析。急性髓系白血病16269例（66%），急性淋巴母细胞白血病835例（3%），7757例（31%）患者白血病类型不详。急性呼吸衰竭（70%）和急性循环衰竭（25%）是住院的主要原因。分别有65%、53%和23%的患者需要有创机械通气、血管加压药物和肾脏替代治疗。51项研究（6,668例患者，其中2,956例在ICU住院期间死亡）的ICU死亡率可获得，meta分析比例为52% (95% CI [47%；57%);I2 93%)。在meta回归中，影响ICU死亡率的变量包括发表年份和插管率。结论：急性呼吸衰竭是急性白血病患者住院的主要原因。机械通气是第一个使用的维持生命的治疗方法，也是死亡率的一个强有力的预测指标。试验注册：本研究方案在PROSPERO上进行了预注册（CRD42023439630）。
Critically ill adult patients with acute leukemia: a systematic review and meta-analysis.
Background: To describe the use of life-sustaining therapies and mortality in patients with acute leukemia admitted to the intensive care unit (ICU).
Methods: The PubMed database was searched from January 1st, 2000 to July 1st, 2023. All studies including adult critically ill patients with acute leukemia were included. Two reviewers independently selected the studies, assessed bias using the Newcastle-Ottawa scale for cohort studies, and performed data extraction from full-text reading. We performed a proportional meta-analysis using a random effects model. The primary outcome was all-cause ICU mortality. Secondary outcomes included reasons for ICU admission, use of organ support therapies (mechanical ventilation, vasopressors and renal replacement therapy), hospital, day-90 and one-year mortality rates.
Results: Of the 1,331 studies screened, 136 (24,861 patients) met the inclusion criteria and were included in the meta-analysis. Acute myeloid leukemia affected 16,269 (66%) patients, acute lymphoblastic leukemia affected 835 (3%) patients, and the type of leukemia was not specified in 7,757 (31%) patients. Acute respiratory failure (70%) and acute circulatory failure (25%) were the main reasons for ICU admission. Invasive mechanical ventilation, vasopressors and renal replacement therapy, were needed in 65%, 53%, and 23% of the patients, respectively. ICU mortality was available in 51 studies (6,668 patients, of whom 2,956 died throughout their ICU stay), resulting in a metanalytical proportion of 52% (95% CI [47%; 57%]; I2 93%). In a meta-regression, variables that influenced ICU mortality included year of publication, and intubation rate.
Conclusion: Acute respiratory failure is the main reason for ICU admission in patients with acute leukemia. Mechanical ventilation is the first life-sustaining therapy to be used, and also a strong predictor of mortality.
Trial registration: This study's protocol was preregistered on PROSPERO (CRD42023439630).
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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