Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study

Abstract

BackgroundThere is limited epidemiologic data on patients with acute myelogenous (myeloid) leukemia (AML) requiring life-sustaining therapies in the intensive care unit (ICU). Our objectives were to describe the clinical characteristics and outcomes in critically ill AML patients.MethodsThis was a retrospective case-control study. Cases were defined as adult patients with a primary diagnosis of AML admitted to ICU at the University of Alberta Hospital between January 1st 2002 and June 30th 2008. Each case was matched by age, sex, and illness severity (ICU only) to two control groups: hospitalized AML controls, and non-AML ICU controls. Data were extracted on demographics, course of hospitalization, and clinical outcomes.ResultsIn total, 45 AML patients with available data were admitted to ICU. Mean (SD) age was 54.8 (13.1) years and 28.9% were female. Primary diagnoses were sepsis (32.6%) and respiratory failure (37.3%). Mean (SD) APACHE II score was 30.3 (10.3), SOFA score 12.6 (4.0) with 62.2% receiving mechanical ventilation, 55.6% vasoactive therapy, and 26.7% renal replacement therapy. Crude in-hospital, 90-day and 1-year mortality was 44.4%, 51.1% and 71.1%, respectively. AML cases had significantly higher adjusted-hazards of death (HR 2.23; 95% CI, 1.38-3.60, p = 0.001) compared to both non-AML ICU controls (HR 1.69; 95% CI, 1.11-2.58, p = 0.02) and hospitalized AML controls (OR 1.0, reference variable). Factors associated with ICU mortality by univariate analysis included older age, AML subtype, higher baseline SOFA score, no change or an increase in early SOFA score, shock, vasoactive therapy and mechanical ventilation. Active chemotherapy in ICU was associated with lower mortality.ConclusionsAML patients may represent a minority of all critically ill admissions; however, are not uncommonly supported in ICU. These AML patients are characterized by high illness severity, multi-organ dysfunction, and high treatment intensity and have a higher risk of death when compared with matched hospitalized AML or non-AML ICU controls. The absence of early improvement in organ failure may be a useful predictor for mortality for AML patients admitted to ICU.

Survival of hematological patients after discharge from the intensive care unit: a prospective observational study

“…Previous studies have demonstrated that when needed, continuation of the chemotherapeutic regimen after ICU admission could improve the outcome of these patients [29]. Our results extend this observation, and suggest that an active therapeutic strategy must be taken after ICU discharge.…”

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…113 In the ICU setting, few data are available for patients with hematological malignancies. 10,114,115 Studies are warranted to evaluate long-term outcome in allo-HSCT long-term ICU survivors. The place of patient and family wishes and implication in the shared decision-making process also needs to be clearly evaluated.…”

A systematic review of prognostic factors at the end of life for people with a hematological malignancy

“…The studies were purely prognostic single cohort studies, with the exception of two. Hill et al [49] and des Ordons et al [44] employed prognostic case-control cohort designs and compared outcomes of people with a hematological malignancy admitted to the ICU against medical controls. The studies with a single cohort included people with a hematological malignancy or in comparison studies, only data on the group with a hematological malignancy were extracted and included in the results of this review.…”

“…No study discussed patients’ socio-economic status or education level. Fourteen studies included all types of hematological malignancies [32, 33, 35, 36, 39, 42, 46–49, 51, 53, 56, 57]; five sampled patients with acute leukemia [38, 40, 41, 44, 54]; eight looked at people who had undergone hematopoietic stem cell transplantation [30, 31, 34, 37, 43, 50, 52, 55]; and one was specifically focused on people with human immunodeficiency virus associated lymphoma [45]. The patient population was predominantly treated with aggressive curative or life-prolonging intent, as most studies ( n  = 24) had admission to the ICU as a criterion for inclusion.…”