在CAR-T细胞治疗后急性损伤:探索临床模式,管理和结果
Maud Vincendeau1, Adrien Joseph1,2, Catherine Thieblemont2,3
1AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, Paris, France.
Clinical kidney journal
|June 25, 2024
概括
急性损伤 (AKI) 影响了34%的CAR-T治疗后的患者,特别是那些严重的细胞因子释放综合征 (CRS) 和高乳酸脱酶 (LDH) 患者. 早期识别AKI对于生存和预防慢性病至关重要.
科学领域:
- 免疫治疗是一种免疫疗法.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
背景情况:
- 急性损伤 (AKI) 是CAR-T细胞治疗后已知的并发症,但综合数据有限.
- 了解AKI发病率,危险因素以及在CAR-T后的重症监护室 (ICU) 设置中的结果至关重要.
研究的目的:
- 为了确定在CAR-T细胞治疗后的ICU患者中AKI的发生率.
- 识别与AKI发展相关的因素.
- 确定结局和死亡率的决定因素.
主要方法:
- 在2017年至2023年期间接受CAR-T细胞治疗的119名ICU患者的回顾性分析.
- 采用多变量分析来确定与AKI,死亡率和脏损伤的关联.
主要成果:
- 在41名患者 (34%) 中发生了AKI.
- 3级以上的细胞因子释放综合征 (CRS) 和乳酸脱酶 (LDH) 水平升高与AKI显著相关.
- AKI (KDIGO ≥2) 是医院死亡率的一个独立风险因素 (P < 0.001).
- 患有AKI的幸存者在6个月 (75%) 和1年 (67%) 时患有慢性病 (CKD) 的发病率很高.
结论:
- 在接受CAR-T治疗的ICU患者中,AKI是一种显著的并发症,与CRS和升高的LDH有关.
- 早期发现AKI至关重要,因为它严重影响生存,并可能导致长期CKD.
- 需要进一步的研究来了解AKI机制,并预测长期的风险.
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