出血事件是血液系统恶性肿瘤危重患者的常见并发症。本研究的目的是评估患有血液系统恶性肿瘤的危重患者的 ICU 获得性严重出血事件的发生率并确定其决定因素。我们进行了一项单中心回顾性研究，纳入了 12 年期间（2007-2018 年）所有有血液系统恶性肿瘤病史、需要计划外入住 ICU 的成年患者。主要终点是 ICU 获得性（即入住 ICU 后第一个 24 小时后）严重出血事件的发生情况，定义为世界卫生组织分类的 3 级或 4 级。总共分析了 1012 名患者，主要包括诊断为淋巴瘤（n = 434，42.9%）和白血病或骨髓增生异常综合征（n = 266，26.3%）。大多数患者最近被诊断出来（n = 340，33.6%），并在过去 3 个月内接受积极的癌症治疗（n = 604，59.7%）。入院的主要原因是感染（n = 479，47.3%），但很大一部分患者因原发性出血入院（n = 99，10%）。入住 ICU 3.0 天 [1.0-7.0] 后，109 名 (10.8%) 患者发生了 ICU 获得性严重出血事件。出血的主要来源是胃肠道（n = 44，40.3%）。经历 ICU 获得性严重出血事件的患者在 ICU 住院时间延长（9.0 天 [1.0-6.0] 对比非出血患者 3.0 天 [3.5-15.0]，p<0.001），并且随着住院时间的增加，结果恶化。 ICU 和院内死亡率（分别为 55% vs. 18.3% 和 65.7% vs. 33.1%，p<0.001）。在多变量分析中，ICU获得性严重出血事件的独立预测因子是慢性肾脏疾病（病因特异性风险2.00 [1.19-3.31]，p = 0.008），这是入ICU时存在的主要出血事件（CSH 4.17 [2.71] -6.43]，p < 0.001），非血小板 SOFA 评分（CSH 每增加 1.06 [1.01-1.11]，p = 0.02）和凝血酶原时间延长（CSH 每增加 5% 0.90 [0.85-0.96]，p = 0.001）在感兴趣事件的前一天。大出血事件是患有血液系统恶性肿瘤的危重患者的常见并发症，并且与预后恶化相关。我们确定了相关的出血风险因素，这可能会促使采取更密切的监测或采取预防措施。© 2024。作者。

Bleeding events are common complications in critically ill patients with haematological malignancies. The objective of this study was to assess the incidence and identify determinants of ICU-acquired severe bleeding events in critically ill patients with haematological malignancies. We conducted a single-center retrospective study including all adult patients with a history of haematological malignancy requiring unplanned ICU admission over a 12-year period (2007-2018). The primary endpoint was the occurrence of ICU-acquired (i.e. after the first 24 h in the ICU) severe bleeding events, as defined as grades 3 or 4 of the World Health Organization classification.A total of 1012 patients were analysed, mainly with a diagnosis of lymphoma (n = 434, 42.9%) and leukaemia or myelodysplastic syndrome (n = 266, 26.3%). Most patients were recently diagnosed (n = 340, 33.6%) and under active cancer treatment within the last 3 months (n = 604, 59.7%). The main cause for admission was infection (n = 479, 47.3%), but a significant proportion of patients were admitted for a primary haemorrhage (n = 99, 10%). ICU-acquired severe bleeding events occurred in 109 (10.8%) patients after 3.0 days [1.0-7.0] in the ICU. The main source of bleeding was the gastrointestinal tract (n = 44, 40.3%). Patients experiencing an ICU-acquired severe bleeding event displayed prolonged in-ICU length of stay (9.0 days [1.0-6.0] vs. 3.0 [3.5-15.0] in non-bleeding patients, p < 0.001) and worsened outcomes with increased in-ICU and in-hospital mortality rates (55% vs. 18.3% and 65.7% vs. 33.1%, respectively, p < 0.001). In multivariate analysis, independent predictors of ICU-acquired severe bleeding events were chronic kidney disease (cause-specific hazard 2.00 [1.19-3.31], p = 0.008), a primary bleeding event present at the time of ICU admission (CSH 4.17 [2.71-6.43], p < 0.001), non-platelet SOFA score (CSH per point increase 1.06 [1.01-1.11], p = 0.02) and prolonged prothrombin time (CSH per 5-percent increase 0.90 [0.85-0.96], p = 0.001) on the day prior to the event of interest.Major bleeding events are common complications in critically ill patients with haematological malignancies and are associated with a worsened prognosis. We identified relevant risk factors of bleeding which may prompt closer monitoring or preventive measures.© 2024. The Author(s).