Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit

Abstract

Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.

Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients

“…Infections, IMV and a high SOFA‐48h on day 3 of ICU stay were independently associated with a decreased ICU survival in our patients. IMV had the highest Odds ratios in both groups and respiratory failure with the need for IMV seems to be the most important risk factor to die for critically ill patients with cancer . The ICU survival of our patients in need for IMV was 27% and did not show any improvement over time.…”

“…IMV had the highest Odds ratios in both groups and respiratory failure with the need for IMV seems to be the most important risk TA B L E 5 Risk groups and associated survival factor to die for critically ill patients with cancer. 28,29 with an increment of the odds ratio for mortality from 2.55 to 5.54. 37 Failure of NIV with the need of secondary intubation is reported to be associated with increased mortality also by other authors.…”

Salvage extracorporeal membrane oxygenation in induction-associated acute respiratory distress syndrome in acute leukemia patients: A case series

“…5,6 Mechanical ventilation is required in 60% of AL patients admitted to the intensive care unit (ICU) and ARDS develops in 37%. 7,8 Survival to ICU discharge is 62%, and 1-year survival ranges from 16% to 29%. [7][8][9][10] It is in the setting of these poor outcomes that ECMO can provide respiratory support while a patient receives appropriate chemotherapy.…”

“…7,8 Survival to ICU discharge is 62%, and 1-year survival ranges from 16% to 29%. 7–10 It is in the setting of these poor outcomes that ECMO can provide respiratory support while a patient receives appropriate chemotherapy.…”

Initiation of venovenous extracorporeal membrane oxygenation in a patient receiving induction chemotherapy for acute myelogenous leukemia

“…3 Approximately 10% of patients in the intensive care unit (ICU) develop acute respiratory distress syndrome (ARDS); 4 the rate is estimated to be much higher (37%) in patients with acute leukemia. 5 Older age, mechanical ventilation, and vasopressor therapy have all been identified as factors predicting ICU mortality in patients with AML. 6 Although rare, venovenous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with hematological malignancies with ARDS.…”