Outcome of critically ill patients with hematological malignancies

Ñamendys‐Silva, Silvio A.; González-Herrera, María O.; García-Guillén, Francisco J.; Texcocano‐Becerra, Julia; Herrera‐Gómez, Ángel

doi:10.1007/s00277-013-1675-7

Cited by 51 publications

(50 citation statements)

References 30 publications

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“…Admission criteria for ICU patients vary from hospital to hospital. Nevertheless, these findings are comparable to recent studies reporting mortality rates of 28–84% [6–9,15,31,33]. However, direct comparison with published mortality rates is complicated by the use of different parameters: death in ICU, death in hospital, or death after 90 days and/or one year.…”

Section: Discussionsupporting

confidence: 85%

Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

Pohlen

Thoennissen

Braess³

et al. 2016

PLoS ONE

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BackgroundThis retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU.Methods and ResultsMultivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operator characteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of ≥25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge.ConclusionsOur data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit from intensive care.

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Section: Discussionsupporting

confidence: 85%

Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

Pohlen

Thoennissen

Braess³

et al. 2016

PLoS ONE

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“…Median mortality across the studies was 54% [45–64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53–74] and 47% [41–68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I 2 = 50%).…”

Section: Resultsmentioning

confidence: 99%

Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

et al. 2016

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PURPOSEWhether neutropenia has an impact on the mortality of critically ill cancer patients remains controversial, yet it is widely used as an admission criterion and prognostic factor.METHODSSystematic review and meta-analysis. Studies on adult cancer patients and intensive care units were searched on PubMed and Cochrane databases (2005-2015). Summary estimates of mortality risk differences were calculated using the random-effects model.RESULTSAmong the 1,528 citations identified, 38 studies reporting on 6,054 patients (2,097 neutropenic patients) were included. Median mortality across the studies was 54% [45–64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53–74] and 47% [41–68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I2 = 50%). The admission period was not associated with how neutropenia affected mortality. Mortality significantly dropped throughout the study decade [−11% (−13.5 to −8.4)]. This mortality drop was observed in non-neutropenic patients [−12.1% (−15.2 to −9.0)] but not in neutropenic patients [−3.8% (−8.1 to +5.6)].Sensitivity analyses disclosed no differences in underlying malignancy, mechanical ventilation use, or Granulocyte-colony stimulating factor use. Seven studies allowed the adjustment of severity results (1,350 patients). Although pooled risk difference estimates were similar to non-adjusted results, there was no significant impact of neutropenia on mortality (risk difference of mortality, 9%; 95% CI, −15 to +33)CONCLUSIONAlthough the unadjusted mortality of neutropenic patients was 11% higher, this effect disappeared when adjusted for severity. Therefore, when cancer patients become critically ill, neutropenia cannot be considered as a decision-making criterion.

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“…& out-pt. setting)All276-MultiModde Montmollin et al, (2013)France [42]RetroAdmitted to ICU, with septic shock, pulmonary origin (multi-centre)All218UniMultiModNamendys-Silva et al, (2013)Mexico [35]ProAdmitted to ICUAll102UniMultiModPrice et al, (2013)USA [40]RetroAdmitted to ICU, requiring ventilationAcute leuk167UniMultiModKripp et al, (2014)Germany [57]ProsAdmitted to palliative care unitAll290UniMultiModBoyaci et al, (2014)Turkey [52]RetroAdmitted to ICUHSCT48UniMultiMod AML acute myeloid leukemia, ICU intensive care unit, HSCT hematopoietic stem cell transplant (allogeneic and autologous), HM hematological malignancy, Cord HSCT umbilical cord (source of stem cells) hematopoietic stem cell transplant, alloHSCT allogeneic hematopoietic stem cell transplant, AKI acute kidney injury, RRT renal replacement therapy, HIV + ve human immunodeficiency virus positive, U univariate statistical analysis / M - multi- multivariable statistical analysis …”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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BackgroundAccurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding ‘bedside’ prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality.MethodsA systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004–2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported ‘bedside’ prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines.ResultsThe search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty ‘bedside’ prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions.ConclusionsThe literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations.Trial registrationThis systematic review was not registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3207-7) contains supplementary material, which is available to authorized users.

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Outcome of critically ill patients with hematological malignancies

Cited by 51 publications

References 30 publications

Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

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

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