Determinants of 6-month survival of critically ill patients with an active hematologic malignancy

Richards, Stephen B.; Wibrow, Bradley; Anstey, Matthew; Sidiqi, M Hasib; Chee, Ashlyn; Ho, Kwok M.

doi:10.1016/j.jcrc.2016.08.022

Cited by 13 publications

(9 citation statements)

References 25 publications

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“…Direct comparisons with other similar studies are difficult, with significant potential variation in intensive care admission criteria and patient population. Nevertheless, the ICU mortality in our cohort was 5%, which was consistent, if not better than seen in recent studies of similar Australian tertiary hospital ICUs, [17][18][19] as well as internationally. 20,21 Mortality at 6 months of 39% similarly compared favourably.…”

Section: Discussionsupporting

confidence: 92%

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Tan

Jacques

Oatley

et al. 2019

Internal Medicine Journal

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Background Patients with advanced malignancies have historically been considered poor candidates for admission to the intensive care unit (ICU); however, prognosis is continually improving, and requirements for ICU access are increasing. Aim To understand the characteristics and outcomes of oncology unit patients admitted to an Australian ICU and identify potential prognostic factors. Methods A single‐centre, retrospective, cohort study conducted at a tertiary public hospital with a quaternary ICU in Sydney, Australia. All patients admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Clinical outcomes were determined including mortality, ICU requirements (ventilation, dialysis, vasopressors, infection) and prognostic scores (Acute Physiologic and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) score). Results There were 96 patients with mean age 61 years, 58% were male and 76% had metastatic disease. Most were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all with melanoma) required ICU admission due to immunotoxicity; 13% were admitted due to an oncological emergency. Mean APACHE II score was 17 (standard deviation (SD) 5.33), mean SOFA score was 3.99 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. Using multivariate logistic regression analysis, cancer stage, infection during ICU admission, intracranial mass effect on ICU admission and SOFA score were associated with 30‐day mortality. Conclusion Our patient population had good short‐term survival outcomes despite most receiving palliative treatment. Cancer patients can achieve positive outcomes after ICU admission, and appropriate selection of patients is crucial.

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Section: Discussionsupporting

confidence: 92%

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Tan

Jacques

Oatley

et al. 2019

Internal Medicine Journal

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“…In addition, we found that hemato-oncologic malignancies as underlying comorbidities were prognostic of survival, likely because hemato-oncologic diseases as comorbidities are associated with an increased risk of critical illness and poor outcome. [26,27,28] Interestingly, we also found that being underweight was prognostic of reduced survival. Because a higher BMI is associated with lower mortality rates based on publish data, [29,30] being underweight would likely be associated with poorer long-term prognosis.…”

Section: Discussionmentioning

confidence: 55%

Factors predicting long-term survival of patients with sepsis on arrival at the emergency department

Roh

Eom

et al. 2019

Medicine

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Predicting long-term outcomes after sepsis is important when caring for patients with this condition. The purpose of the present study was to develop models predicting long-term mortality of patients with sepsis, including septic shock.Retrospective data from 446 patients with sepsis (60.8% men; median age, 71 years) treated at a single university-affiliated tertiary care hospital over 3 years were reviewed. Binary logistic regression was used to identify factors predicting mortality at 180 and 365 days after arrival at the emergency department. Long-term prognosis scores for the 180- and 365-day models were calculated by assigning points to variables according to their β coefficients.The 180- and 365-day mortality rates were 40.6% and 47.8%, respectively. Multivariate analysis identified the following factors for inclusion in the 180- and 365-day models: age ≥65 years, body mass index ≤18.5 kg/m2, hemato-oncologic diseases as comorbidities, and ventilator care. Patients with scores of 0 to ≥3 had 180-day survival rates of 83.8%, 70.8%, 42.3%, and 25.0%, respectively, and 365-day survival rates of 72.1%, 64.6%, 36.2%, and 15.9%, respectively (all differences P < .001; log-rank test). The areas under the receiver operating characteristic curves of the 180- and 365-day models were 0.713 (95% confidence interval [CI] 0.668–0.756, P < .001) and 0.697 (95% CI 0.650–0.740, P < .001), respectively.These long-term prognosis models based on baseline patient characteristics and treatments are useful for predicting the 6- and 12-month mortality rates of patients with sepsis.

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“…The mortality rates described in this study are comparable to other contemporary Western data and also to the few Australian studies available. 21 , 23 The high volume of HM admissions within this particular Australian ICU and the corresponding favorable outcomes of many of the patients reinforce the concept of a “specialized” ICU that is essential to improved outcome. 4 This retrospective study is an important step in recognizing the changing contexts of ICU referrals in HM and planning prospective studies to understand the ICU outcomes for these patients.…”

Section: Discussionmentioning

confidence: 86%

Intensive care unit outcomes in patients with hematological malignancy

et al. 2020

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Hematological malignancies are usually life-limiting conditions. Limitations of care need to be decided early, based on acceptability to the patient, family, physician, and community. Inappropriate intensive care unit (ICU) admission is likely to result in significant physical, psychological, and economic burden. There is little published on the impact of non-acute preadmission disease factors on ICU outcomes in hematological malignancies. Aim: To identify baseline performance and disease-associated factors before admission to ICU in patients with hematological malignancy that contribute to subsequent ICU mortality. Methods: A retrospective analysis of electronic medical records, laboratory results, and Intensive Care data for all patients ( n = 184) with hematological malignancy admitted to the Calvary Mater Hospital ICU between January 1, 2013 and June 30, 2017 was undertaken. Baseline age, gender, condition, Eastern Cooperative Oncology, and Charlson Comorbidity scores were compared to ICU outcome and overall survival. Disease-specific prognostic risk scores were compared to ICU outcome. Results: Overall, 73.9% survived the ICU admission, with 31.6% surviving at 12 months. Superior ejection fractions (>55%) and prognosis >12 months (based on disease-specific risk scores) were significantly associated with overall survival ( P = 0.024 and P = 0.001). Induction and posttransplantation therapy were predictive of poor ICU survival outcome ( P < 0.0001 and P = 0.041). APACHE scores were significant predictors of ICU mortality ( P = 0.002 for APACHE II and P < 0.0001 for APACHE III). Conclusion: Survival outcomes for patients with hematological malignancy admitted to the ICU correlate with functional and comorbidity status. Disease-specific prognostic scores can assist in recognizing patients likely to benefit from ICU admission.

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Determinants of 6-month survival of critically ill patients with an active hematologic malignancy

Cited by 13 publications

References 25 publications

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit

Factors predicting long-term survival of patients with sepsis on arrival at the emergency department

Intensive care unit outcomes in patients with hematological malignancy

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