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

Pohlen, Michele; Thoennissen, Nils H.; Braess, Jan; Thudium, Johannes; Schmid, Christoph; Kochanek, Matthias; Kreuzer, Karl‐Anton; Lebiedz, Pia; Görlich, Dennis; Gerth, Hans Ulrich; Rohde, Christian; Keßler, Torsten; Müller‐Tidow, Carsten; Stelljes, Matthias; Büchner, Thomas; Schlimok, Günter; Hallek, Michael; Waltenberger, Johannes; Hiddemann, Wolfgang; Berdel, Wolfgang E.; Heilmeier, Bernhard; Krug, Utz

doi:10.1371/journal.pone.0160871

Cited by 15 publications

(9 citation statements)

References 41 publications

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“…In addition, in prior studies of patients with hematologic malignancies, the need for more than 1 life-sustaining therapy was associated with higher in-hospital mortality. 5,[7][8][9][10] Similarly, in our cohort of older patients with AML, the need for 2 or more life-sustaining therapies portended a particularly poor prognosis that should be incorporated into clinical discussions with patients and families.…”

Section: Discussionmentioning

confidence: 96%

“…[5][6][7][8][9][10] Two prior retrospective studies examined outcomes of younger patients with AML (median age, <55 years) receiving intensive chemotherapy who were admitted to the ICU. [5][6][7][8][9][10] Two prior retrospective studies examined outcomes of younger patients with AML (median age, <55 years) receiving intensive chemotherapy who were admitted to the ICU.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies have shown that patients with hematologic malignancies who are admitted to the ICU can have 90-day survival rates of approximately 50% to 60% with good functional outcomes. [5][6][7][8][9][10] Two prior retrospective studies examined outcomes of younger patients with AML (median age, <55 years) receiving intensive chemotherapy who were admitted to the ICU. These studies have shown generally similar rates of survival.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Slavin

Fenech

Jankowski

et al. 2019

Cancer

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BACKGROUND: Older adults with acute myeloid leukemia (AML) are often assumed to have poor outcomes after admission to the intensive care unit (ICU). However, little is known about ICU utilization and post-ICU outcomes in this population. METHODS: The authors conducted a retrospective analysis for 330 patients who were 60 years old or older and were diagnosed with AML between 2005 and 2013 at 2 hospitals in Boston.They used descriptive statistics to examine the proportion of patients admitted to the ICU as well as their mortality and functional recovery. They used logistic regression to identify risk factors for in-hospital mortality. RESULTS: Ninety-six patients (29%) were admitted to the ICU, primarily because of respiratory failure (39%), septic shock (28%), and neurological compromise (9%). The proportions of patients who survived to hospital discharge, 90 days, and 1 year were 47% (45 of 96), 35% (34 of 96), and 30% (29 of 96), respectively. At 90 days, 76% of the patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1, and 86% were in complete remission (CR) and/or continued to receive AML-directed therapy. In a multivariate analysis, a poorer baseline ECOG PS score (odds ratio, 2.76; P = .013) and the need for 2 or more life-sustaining therapies (ie, vasopressors, invasive ventilation, and/or renal replacement therapy; odds ratio, 12.4; P < .001) were associated with increased odds of in-hospital mortality. CONCLUSIONS: Although almost one-third of older patients with AML are admitted to an ICU, nearly half survive to hospital discharge with good functional outcomes. The baseline performance status and the need for 2 or more life-sustaining therapies predict hospital mortality. These data support the judicious use of ICU resources for older patients with AML. Cancer 2019;125:3845-3852.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Slavin

Fenech

Jankowski

et al. 2019

Cancer

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“… 4 However, some specific malignancy groups, including diffuse large B-cell lymphoma and subtypes of acute myeloid leukemia (AML), show favorable long-term prognosis if they survive the critical illness in ICU. 4 , 9 , 12 , 13 Furthermore, the time course of the disease, such as newly diagnosed or relapsed, is likely a risk factor for higher ICU mortality. 9 A previous analysis by Massion et al (2002) suggest that HM may determine long-term survival but not ICU or hospital survival.…”

Section: Introductionmentioning

confidence: 99%

“… 14 Well-validated prognostic markers such as disease-specific risk scores and cytogenetic markers can predict survival from HM, but their applicability to ICU survival has not been explored. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

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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Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study

Herault,

Hourmant,

Lengliné

et al. 2024

Journal of Intensive Medicine

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

Cited by 15 publications

References 41 publications

Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Intensive care unit outcomes in patients with hematological malignancy

Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study

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