Mortality of Patients with Hematological Malignancy after Admission to the Intensive Care Unit

Abstract

Background: The admission of patients with malignancies to an intensive care unit (ICU) still remains a matter of substantial controversy. The identification of factors that potentially influence the patient outcome can help ICU professionals make appropriate decisions. Patients and Methods: 90 adult patients with hematological malignancy (leukemia 47.8%, high-grade lymphoma 50%) admitted to the ICU were analyzed retrospectively in this single-center study considering numerous variables with regard to their influence on ICU and day-100 mortality. Results: The median simplified acute physiology score (SAPS) II at ICU admission was 55 (ICU survivors 47 vs. 60.5 for non-survivors). The overall ICU mortality rate was 45.6%. With multivariate regression analysis, patients admitted with sepsis and acute respiratory failure had a significantly increased ICU mortality (sepsis odds ratio (OR) 9.12, 95% confidence interval (CI) 1.1– 99.7, p = 0.04; respiratory failure OR 13.72, 95% CI 1.39–136.15, p = 0.025). Additional factors associated with an increased mortality were: high doses of catecholamines (ICU: OR 7.37, p = 0.005; day 100: hazard ratio (HR) 2.96, p < 0.0001), renal replacement therapy (day 100: HR 1.93, p = 0.026), and high SAPS II (ICU: HR 1.05, p = 0.038; day 100: HR 1.2, p = 0.027). Conclusion: The decision for or against ICU admission of patients with hematological diseases should become increasingly independent of the underlying malignant disease.

Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis

“…This is the first descriptive analysis in the US evaluating PBT patients with an unplanned admission to an ICU. Our ICU mortality rate of 19% was similar to two similar French studies of PBT patients (22–23%) [ 6 , 7 ], similar to patients with solid tumors (17–23%) [ 4 , 8 ], better than patients with hematologic malignancies (40–46%) [ 4 , 21 , 22 ] and within the range expected for general ICU patients (3.4–66.7%) [ 9–12 ]. In addition to similar ICU mortality, our most common reasons for admission were similar to the two prior studies conducted in France: seizures and respiratory failure [ 6 , 7 ].…”

Predictors of intensive care unit admission in patients with hematologic malignancy

“…The early and short-term mortality rates for ICU admitted patients were high (cumulative mortality rates at 1 month 34% and at 6 months 53%). This is similar to previous data, which report a range of in-hospital mortality of 46-90% 1,[4][5][6][11][12][13][14][15][16][17][18][19][20][21][22] , with multi-organ dysfunction (illustrated by use of mechanical ventilation, vasopressor use, renal replacement therapy, significant liver enzyme elevation, high Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), or Simplified Acute Physiology Score (SAPS) scores) being the most common predictor of death 1,[4][5][6][11][12][13][14][15][16][17][18][19][20][21][22] . This was further confirmed in larger studies including a literature review of observational studies encompassing 10,000 patients 23 , and a retrospective analysis of 7689 patients with hematologic malignancy admitted to the ICU 24 .…”

“…ICU morbidity and mortality remain an important issue for patients with hematologic malignancy. Although predictors of mortality in patients admitted to ICU with hematologic malignancy are well described 1,[4][5][6][11][12][13][14][15][16][17][18][19][20][21][22] , there is a paucity of evidence that identifies the predictors of ICU admission in this population, or predictors of survival in hospitalized patients with hematologic malignancies. Overall, during a period of 5.5 years, 19% of patients with hematologic malignancies admitted to our tertiary care hospital were admitted to an ICU at least once, with 47% of these admissions to a high acuity (versus step-down) ICU.…”

Outcomes of Patients with Malignancy Admitted to the Intensive Care Units: A Prospective Study

“…Gupta et al found SOFA scores, hypotension, and septic shock to be predictors of mortality in their multivariate analysis [ 17 ]. Sepsis, acute respiratory failure, high doses of catecholamines, renal replacement therapy, and high SAPS II scores were found to be predictive of mortality in multivariate analysis done by Horster et al in 2012 [ 23 ].…”