背景
瓦尔堡效应的特征是乳酸水平升高，但没有组织缺氧或休克，已在患有侵袭性淋巴增殖性恶性肿瘤的患者中得到描述。然而，对该人群的临床特征和长期结果仍知之甚少。
方法
我们回顾性分析了 2017 年 1 月至 2022 年 12 月入住 ICU 的 135 例侵袭性淋巴增殖性恶性肿瘤患者。患者被分为三组：临床 Warburg 效应 (CWE)、无高乳酸水平的 Warburg (NW-HL) 和无 Warburg 的高乳酸水平 (NW-HL)。正常乳酸水平 (NW-NL)。比较各组之间的临床特征和结果，并使用多变量分析确定与 1 年死亡率和 CWE 相关的因素。
结果
在 135 名患者中，46 名 (34%) 患有 CWE。与其他组相比，该组患有伯基特淋巴瘤和 T 细胞淋巴瘤的比例更高，肿瘤负荷更大，骨和大脑受累更频繁。1 年时，72 名患者 (53%) 死亡，CWE 和 NW-HL 组（各 70%）的死亡率显着高于 NW-NL 组（38%）。与 1 年死亡率独立相关的因素包括年龄 [HR = 1.02 CI 95% (1.00–1.04)]、入院时 SOFA 总分 [HR = 1.19 CI 95% (1.12–1.25)] 和 CWE [HR = 3.87 CI 95%（2.13–7.02）]。与 CWE 相关的主要因素是肿瘤溶解综合征 [OR = 2.84 CI 95% (1.14–7.42)]、潜在恶性肿瘤的骨受累 [OR = 3.58 CI 95% (1.02–12.91)]、总 SOFA 评分入院时[OR = 0.81 CI 95% (0.69–0.91)]和入院时低血糖[OR = 14.90 CI 95% (5.42–47.18)]。
结论
与没有这种情况的患者相比，CWE 与较高的肿瘤负荷和较高的 1 年死亡率相关。我们的研究结果强调了将 CWE 患者视为高危人群的重要性，因为尽管不需要先进的器官支持，但他们的结果与淋巴瘤和休克患者的结果非常相似。临床医生应认识到管理这些患者的紧迫性，并考虑早期干预以改善其预后。
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Clinical Warburg effect in lymphoma patients admitted to intensive care unit
Background
The Warburg effect, characterized by elevated lactate levels without tissue hypoxia or shock, has been described in patients with aggressive lymphoproliferative malignancies. However, the clinical characteristics and long-term outcomes in this population remain poorly understood.
Methods
We retrospectively analyzed 135 patients with aggressive lymphoproliferative malignancies admitted to the ICU between January 2017 and December 2022. Patients were classified into three groups: Clinical Warburg Effect (CWE), No Warburg with High Lactate level (NW-HL), and No Warburg with Normal Lactate level (NW-NL). Clinical characteristics and outcomes were compared between the groups and factors associated with 1-year mortality and CWE were identified using multivariable analyses.
Results
Of the 135 patients, 46 (34%) had a CWE. This group had a higher proportion of Burkitt and T cell lymphomas, greater tumor burden, and more frequent bone and cerebral involvement than the other groups. At 1 year, 72 patients (53%) died, with significantly higher mortality in the CWE and NW-HL groups (70% each) than in the NW-NL group (38%). Factors independently associated with 1-year mortality were age [HR = 1.02 CI 95% (1.00–1.04)], total SOFA score at admission [HR = 1.19 CI 95% (1.12–1.25)], and CWE [HR = 3.87 CI 95% (2.13–7.02)]. The main factors associated with the CWE were tumor lysis syndrome [OR = 2.84 CI 95% (1.14–7.42)], bone involvement of the underlying malignancy [OR = 3.58 CI 95% (1.02–12.91)], the total SOFA score at admission [OR = 0.81 CI 95% (0.69–0.91)] and hypoglycemia at admission [OR = 14.90 CI 95% (5.42–47.18)].
Conclusion
CWE is associated with a higher tumor burden and increased 1-year mortality compared to patients without this condition. Our findings underscore the importance of recognizing patients with CWE as a high-risk cohort, as their outcomes closely resemble those of individuals with lymphoma and shock, despite not requiring advanced organ support. Clinicians should recognize the urgency of managing these patients and consider early intervention to improve their prognosis.
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