Characteristics and predictors of mortality of patients with hematologic malignancies requiring invasive mechanical ventilation

Abstract

RATIONALE:Acute respiratory failure (ARF) may complicate the course of hematologic malignancies (HMs). Our objective was to study the characteristics, outcomes and predictors of mortality of patients with HMs who required intubation for ARF.METHODS:This retrospective cohort study evaluated all patients with HMs who were admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City-Riyadh between 2008 and 2013 and required invasive mechanical ventilation. We noted their baseline characteristics, treatments and different outcomes. Multivariable logistic regression analysis was performed to evaluate predictors of hospital mortality.RESULTS:During the 6-year period, 190 patients with HMs were admitted to the ICU and 122 (64.2%) required intubation for ARF. These patients had mean age of 57.2 ± 19.3 years and Acute Physiology and Chronic Health Evaluation II score of 28.0 ± 7.8 and were predominantly males (63.4%). Lymphoma (44.3%) and acute leukemia (38.5%) were the most common hematologic malignancy. Noninvasive ventilation (NIV) was tried in 22 patients (18.0%) but failed. The code status was changed to “Do-Not-Resuscitate” for 39 patients (32.0%) during ICU stay. Hospital mortality was 70.5% and most deaths (81.4%) occurred in the ICU. The mortality of patients with “Do-Not-Resuscitate” status was 97.4%. On multivariable logistic regression analysis, male gender (odds ratio (OR), 6.74; 95% confidence interval (CI), 2.24–20.30), septic shock (OR, 6.61; 95% CI, 1.93–22.66) were independent mortality predictors. Remission status, non-NIV failure and chemotherapy during ICU stay were not associated with mortality.CONCLUSIONS:Patients with HMs requiring intubation had high mortality (70.5%). Male gender and presence of septic shock were independent predictors of mortality.

Survival of mechanically ventilated patients admitted to intensive care units

“…Thus at a national level, many studies have been carried out that estimated mortality as one of many outcomes of patients admitted to ICUs 11. Thus, a limited number of studies has addressed this issue among patients with certain conditions such as malignancy or acute renal failure 13,25. An important consideration in our study was the outbreak of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection that occurred during the study period.…”

Salvage extracorporeal membrane oxygenation in induction-associated acute respiratory distress syndrome in acute leukemia patients: A case series

“…15 Although the differential diagnosis of respiratory failure in HMs is similar to the AL subset, studies have suggested that a higher rate of infectious etiologies may be responsible for respiratory failure in HM patients. 16,17 The AL cases described here suggested an ARDS etiology of leukemic infiltration, leukostasis, and lysis pneumopathy, with two cases also having chest radiographic features concerning for invasive fungal infections. These etiologies represent potentially reversible causes of respiratory failure-if patients are given appropriate respiratory support while receiving chemotherapeutic interventions.…”

Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report

“…The mortality of acute pneumonia for patients with hematologic malignancies is high compared to patients without [ 16 ]. The number of patients requiring ICU treatment over the last decade has increased with the development of chemotherapy for hematological malignancies and its resulting expansion of indications for chemotherapy [ 17 , 18 ]. In contrast, the mortality of patients who require mechanical ventilation for pneumonia associated with the treatment of hematological malignancies is still high at approximately 70% [18].…”