急性呼吸衰竭（ARF）是急性髓系白血病（AML）患者进入重症监护病房（ICU）的最主要原因，需要有关影响短期结局的预后因素的数据。本研究是对ICU收治免疫抑制患者ARF的多中心、国际前瞻性队列研究的事后分析。我们评估了AML和ARF患者的住院死亡率及相关危险因素，并通过集群分析定义了研究人群中的特定亚组。总共，1611名免疫抑制患者中有201名患有AML并纳入了分析。住院死亡率为46.8%。与死亡有独立关联的变量包括ECOG评分≥2（OR=2.79，p=0.04）、咳嗽（OR=2.94，p=0.034）、使用血管活性药物（OR=2.79，p=0.044）、白血病特异性肺部受累[包括白血病高浓度、肺部充满增生细胞或急性溶解性肺病（OR=4.76，p=0.011）]和肝脏SOFA评分（OR=1.85，p=0.014）。局灶性肺泡影在存活中存在关联（OR=0.13，p=0.001）。我们确定了三个集群，并根据每个集群中最常见的临床、生物学和放射学特征命名为“白血病集群”、具有孤立性、轻微ARF的高危AML患者的“肺集群”、包括除ARF外还有多器官功能衰竭的“炎症性集群”。在多变量分析中，第2和第3集群与住院死亡率独立相关。在ARF的AML患者中，与不良结局有关的因素涉及患者背景（ECOG评分、白血病肺受累）、症状、放射学结果、对血管活性药物的需求以及肝脏SOFA评分。我们确定了AML患者中的三种特定ARF综合征，这些综合征具有预后意义，并可指导临床医生优化管理策略。©2023年. 法国重症医学协会 （SRLF）

Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed.This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis.Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality.Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).