Background: Immune-related adverse events (iRAEs) are known complications of immune checkpoint inhibitors (ICIs). Early identification and management leads to improved morbidity and mortality. This study seeks to address our center’s experience with iRAEs in the emergency department (ED). Methods: We performed a retrospective review of patients treated with ICIs in 2018 and 2019 for any indication. All diagnoses of iRAEs were recorded. For all patients who presented to the ED following administration of an ICI, we assessed whether the presenting symptoms were eventually diagnosed as an iRAE. We assessed disposition, time to initiation of corticosteroids and outcomes in these patients. Results: 351 evaluable patients were treated with an ICI, 129 patients (37%) had at least one presentation to the ED, 17 of whom presented with symptoms due to a new iRAE. New iRAE diagnoses were broad, occurred after median 2 cycles, majority irAEs were grade 3 or higher (70.6%), and two patients died due to toxicity. Twelve patients were admitted to the hospital during initial presentation or at follow-up, four required ICU care. All patients required immunosuppressive therapy, and only three were later re-challenged with an ICI. Of the patients who were admitted to the hospital, median time to first dose of corticosteroid was 30.5 h (range 1–269 h). Conclusions: Patients on ICI have a significant risk of requiring an ED visit. A notable proportion of iRAEs have their first presentation at the ED and often can present in a very nonspecific manner. A standardized approach in the ED at the time of presentation may lead to improved identification and management of these patients.

中文翻译：

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接受免疫检查点抑制剂患者的急诊科使用：对出现免疫相关不良事件的患者的识别和结果的回顾性分析

背景：免疫相关不良事件 (iRAE) 是免疫检查点抑制剂 (ICI) 的已知并发症。早期识别和管理可提高发病率和死亡率。本研究旨在解决我们中心在急诊科 (ED) 中使用 iRAE 的经验。方法：我们对 2018 年和 2019 年接受 ICI 治疗的患者的任何适应症进行了回顾性研究。记录了所有 iRAE 的诊断。对于所有在使用 ICI 后就诊到 ED 的患者，我们评估了出现的症状是否最终被诊断为 iRAE。我们评估了这些患者的处置、开始使用皮质类固醇的时间和结果。结果：351 名可评估的患者接受了 ICI 治疗，129 名患者 (37%) 至少有一次就诊于 ED，其中 17 人因新的 iRAE 出现症状。新的 iRAE 诊断范围广泛，发生在中位 2 个周期后，大多数 irAE 为 3 级或更高 (70.6%)，两名患者因毒性而死亡。12 名患者在初次就诊或随访期间入院，其中 4 名需要 ICU 护理。所有患者都需要免疫抑制治疗，只有 3 人后来再次接受 ICI 治疗。在入院的患者中，首次使用皮质类固醇的中位时间为 30.5 小时（范围 1-269 小时）。结论：接受 ICI 的患者有很大的风险需要到 ED 就诊。显着比例的 iRAE 在急诊部首次出现，并且通常以非常非特异性的方式出现。