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16001 Background: Recent advances in oncology and critical care have resulted in improved survival in critically ill cancer patients. An appraisal of the prognosis of critically ill patients with lung cancer is timely. Methods: The aim of this study was to evaluate the outcomes and prognostic factors of critically ill cancer patients with lung cancer. From 2000 to 2005, patients with either small-cell (SCLC) or non-small-cell lung cancer (NSCLC) admitted at two intensive care units (ICU) in Brazil and France were included. Patients with postoperative care, ICU stay <24 h and readmissions were excluded. Demographics, clinical, cancer related and outcome variables were collected. Hospital mortality was the outcome variable of interest. Variables selected in the univariate analysis (p < 0.25) and those considered clinically relevant were entered in a multivariable logistic regression analysis [results were expressed as odds-ratios (OR), 95% confidence interval (CI)]. Results: A total of 132 patients were studied (INCA = 87, St Louis Hospital = 45). Their mean age was 61 ± 10 years and 73% were males. Twenty-five (19%) had SCLC and 107 (81%), NSCLC. The SAPS II score was 48 ± 21 points. The main reasons for ICU admission were severe sepsis (45%) and acute respiratory failure (33%). During ICU stay, 96 (73%) patients received mechanical ventilation, 76 (58%) vasopressors and 11 (8%) dialysis; 15 (11%) patients were treated with chemotherapy and 6 (5%), radiation therapy. Thirty-eight (29%) patients had end-of-life decisions. ICU and hospital mortality were 43% and 60%, respectively. Multivariable analysis identified three independent determinants of hospital mortality: airway obstruction/infiltration by cancer [OR = 2.87 (1.34–8.13), p < 0.001], number of organ failures [OR = 1.91 (1.01–2.74), p = 0.047] and performance status 3–4 before admission [OR = 2.90 (0.94–8.95), p = 0.065]. Conclusions: Improved survival in overall ICU cancer patients extends to patients with lung cancer, including those needing mechanical ventilation. Interestingly, the characteristics of the cancer are not associated with the outcome and should not be the grounds for the ICU decision making. Mortality is increased with the number of organ dysfunctions, in particular when respiratory failure is due to cancer progression. No significant financial relationships to disclose.

BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

4364 INTRODUCTION: Acute Myeloblastic Leukemia (AML) is considered as an oncology emergency as a proportion of patients experience life threatening complications within the first hours or days after diagnosis. Early death had been demonstrated to be statistically related to high white blood cell (WBC) and monoblastic leukemia, with leukostasis and lysis syndrome as the most deadful events. OBJECTIVES: To evaluate the relationship between timing of admission to the Intensive Care Unit (ICU) and outcomes in high risk AML patients at the earliest phase of the malignancy (before any chemotherapy) METHODS: Retrospective study in a tertiary care center teaching hospital between 1998 and 2008. Adult patients with newly diagnosed AML were included. Patients admitted for an immediate life sustaining therapy (ventilation, vasopressors or renal replacement therapy) were excluded. 42 patients admitted directly to the ICU (Early admission) were matched for age, WBC and FAB subtype with 42 patients primarily admitted in hematology ward. Medical charts were reviewed and datasets extracted. RESULTS: Overall 84 patients were included in the study (42 patients early admitted to the ICU and 42 patients admitted first to the wards). Median follow up was 10,3 months. Median age was 46,5 years (36-57). FAB M4 or M5 was retrieved in 58% of the patients. According to MRC, karyotype was favorable for 30% and poor for 19%. Median WBC was 103×109.L-1. No statistical difference was seen for demographic and hematological parameters between early admitted patients and matched controls. Among the 42 patients admitted first to the wards (controls), 20 were subsequently admitted to the ICU (Lately admitted) and 22 remained in ward during the entire treatment course (Never admitted). The median time between diagnostic and ICU admission of this last group was 4 (1-9) days. Strikingly, patients lately admitted had more frequently dyspnea, oxygen requirement, high respiratory rate, low diastolic arterial pressure and lower first 24h urine output (p<0,05 for each). Lately admitted patients were less likely to receive the complete dose of induction chemotherapy than early admitted patients (68% vs. 88%,p<0,05) Furthermore, Late admission resulted in increased use of invasive mechanical ventilation (60 vs. 33%) and vaso-active drugs (60 vs. 16%,p<0,05) These differences resulted in longer stay in ICU and decreased survival. CONCLUSIONS: Patients at the earliest phase of High risk AML who are lately admitted to the ICU experience worse outcomes, with increased use of life-sustaining therapies and higher mortality, compared to patients early admitted to the ICU. Physiologic parameters at the time of AML diagnosis such as respiratory rate, diastolic blood pressure, SpO2, or oxygen need are likely to help clinicians distinguish those patients at risk of late ICU admission and subsequent adverse outcomes. Studies are needed to assess the right place for newly diagnosed AML with physiological abnormalities but no organ dysfunction. Disclosures: No relevant conflicts of interest to declare.