Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies

Kroschinsky, Frank; Weise, Matthias; Illmer, Thomas; Haenel, Mathias; Bornhaeuser, Martin; Hoeffken, Gert; Ehninger, Gerhard; Schuler, U

doi:10.1007/s00134-002-1420-5

Cited by 118 publications

(76 citation statements)

References 29 publications

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“…Factors that consistently predict poor outcome in patients admitted to the CCU with haematological malignancies include: invasive mechanical ventilation [16][17][18], multiple organ dysfunction, and increasing severity-of-illness score (Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, or Intensive Care National Audit and Research Centre (ICNARC) score) [2,4,5,15,19]. APACHE II is the most accurate score in this group of patients [2]; however it may still underestimate mortality in HM patients [1].…”

Section: Introductionmentioning

confidence: 99%

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Hampshire¹,

Pugh²,

Hajimichael³

2014

J Cancer Ther Res

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Background: Patients with haematological malignancies admitted to critical care units have a high mortality. Specialist cancer centres may demonstrate better survival rates than non-specialist centres. We compared the outcomes of patients with haematological malignancies admitted to three different centres in the United Kingdom, and examined possible reasons for differences in outcomes. Methods: We compared the characteristics and outcomes of patients with haematological malignancies admitted to critical care units at the Christie, Royal Liverpool University and Glan Clwyd hospitals between 1st January 2007 and 1st July 2011. Differences between hospitals were compared using ANOVA or Chi-squared test, as appropriate. Factors associated with hospital mortality were analysed using logistic regression analysis. Results: 187 patients with haematological malignancies were identified. More patients with Hodgkin's lymphoma were admitted to Glan Clwyd hospital (25%) compared to Royal Liverpool (5.8%) and the Christie (8.1%), p=0.0087. Patients admitted to the Christie had lower severity-of-illness scores compared to patients admitted to the other hospitals (p<0.001). Overall, 91 patients died before hospital discharge (48.7%). Unadjusted hospital mortality at the Christie was significantly lower (41.4%), compared to the Royal Liverpool (61.5%) and Glan Clwyd hospitals (54.2%), p=0.0240. On logistic regression analysis, the only factor associated with higher odds of hospital mortality was increasing APACHE II score (p=0.035, odds ratio 1.06 [95% CI 1.04-1.13] per point). Admission to a non-specialist centre was associated with higher odds of critical care unit mortality (p=0.036, odds ratio 2.17 [95% CI 1.05-4.46]), but was not associated with higher odds of hospital mortality (p=0.065). Conclusions: Admission to a specialist centre was not associated with lower hospital mortality compared to non-specialist centres for patients with haematological malignancies. However, admission to a specialist centre was associated with lower critical care unit mortality. Possible explanations for these differences in survival between centres could be the identified significant differences in casemix, or lower severity of illness at admission. In addition the severity of illness on admission to the critical care unit as indicated by the APACHE II score increased the odds of hospital mortality.

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Section: Introductionmentioning

confidence: 99%

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Hampshire¹,

Pugh²,

Hajimichael³

2014

J Cancer Ther Res

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“…This is in line with several reports showing that the ICU survival of patients with hematologic malignancies might not depend on disease-related parameters, but rather on the severity of the acute illness. 17,38,39,41,[43][44][45][46] Long-term survival of patients with hematologic malignancies has been described to be independent of the severity of disease at ICU admission but rather associated with disease-related parameters. 17,38,39,44 Our analysis, albeit retrospective in nature, is one of the first to investigate a consecutive homogeneous cohort of patients with a distinct hematologic disease (AML) in detail, starting from the day of diagnosis and focusing on a possible independent effect of an ICU admission on outcome.…”

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confidence: 99%

Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

Schellongowski¹,

Staudinger²,

Kundi³

et al. 2010

Haematologica

119

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BackgroundAcute myeloid leukemia is a life-threatening disease associated with high mortality rates. A substantial number of patients require intensive care. This investigation analyzes risk factors predicting admission to the intensive care unit in patients with acute myeloid leukemia eligible for induction chemotherapy, the outcome of these patients, and prognostic factors predicting their survival. Design and MethodsA total of 406 consecutive patients with de novo acute myeloid leukemia (15-89 years) were analyzed retrospectively. Markers recorded at the time of diagnosis included karyotype, fibrinogen, C-reactive protein, and Charlson comorbidity index. In patients requiring critical care, the value of the Simplified Acute Physiology Score II, the need for mechanical ventilation, and vasopressor support were recorded at the time of intensive care unit admission. The independent prognostic relevance of the parameters was tested by multivariate analysis. ResultsSixty-two patients (15.3%) required intensive care, primarily due to respiratory failure (50.0%) or life-threatening bleeding (22.6%). Independent risk factors predicting intensive care unit admission were lower fibrinogen concentration, the presence of an infection, and comorbidity. The survival rate was 45%, with the Simplified Acute Physiology Score II being the only independent prognostic parameter (P<0.05). Survival was inferior in intensive care patients compared to patients not admitted to an intensive care unit. However, no difference between intensive care and non-intensive care patients was found concerning continuous complete remission at 6 years or survival at 6 years in patients who survived the first 30 days after diagnosis (nonintensive care patients: 28%; intensive care patients: 20%, P>0.05). ConclusionsOngoing infections, low fibrinogen and comorbidity are predictive for intensive care unit admission in acute myeloid leukemia. Although admission was a risk factor for survival, continuous complete remission and survival of patients alive at day 30 were similar in patients who were admitted or not admitted to an intensive care unit.Key words: acute myeloid leukemia, intensive care unit, outcome, infection.Citation: Schellongowski P, Staudinger T, Kundi M, Laczika K, Locker GJ, Bojic A, Robak O, Fuhrmann V, Jäger U, Valent P, and Sperr WR. Prognostic IntroductionAcute myeloid leukemia (AML) is a life-threatening stem cell disorder characterized by rapid and uncontrolled proliferation and accumulation of myeloblasts.1,2 The prognosis and clinical course of AML differs among patients depending on specific molecular and cytogenetic properties of the clone.1-9 Moreover, apart from diseaseassociated features, patient-related factors including age and pre-or co-existing diseases (comorbidity) are of prognostic importance. 1,[10][11][12] Although the rate of complete remission in AML patients is relatively high (ranging between 60 and 75%), only a small percentage of patients are permanently cured. [12][13][14] Patients with AML usually pres...

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“…Most scoring systems currently in use, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II, 18 the Simplified Acute Physiology Score (SAPS II), 19 and the Sequential Organ Failure Assessment (SOFA), 20 were constructed and validated in general ICU populations, not in specific groups of patients, such as patients with underlying malignant neoplasms. The results of evaluations of these general prognostic models in cohorts of cancer patients have been either positive 17,[21][22][23][24][25][26][27] or negative. 16,[27][28][29] Taking these factors into account, we conducted this study to determine the characteristics and outcomes of cancer patients admitted to the ICU, identify risk factors associated with mortality, evaluate and compare the effectiveness of established general scoring systems (APACHE II, SAPS II, and SOFA) in the prediction of ICU mortality of cancer patients, and determine if the addition of other predictors of mortality to these established scoring systems could improve their performance.…”

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confidence: 99%

General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

Kopterides¹,

Liberopoulos²,

Ilias³

et al. 2010

American Journal of Critical Care

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Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies

Cited by 118 publications

References 29 publications

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

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