Prognosis of patients with acute myeloid leukaemia admitted to intensive care

Abstract

Summary This retrospective study assessed the prognostic factors associated with early and long‐term outcome in consecutive patients with acute myeloid leukaemia (AML) admitted to the intensive care unit (ICU) over a 9‐year period. A total of 83 patients were studied (age 48 ± 16 years), among whom 60% were neutropenic on admission. For 68%, admission occurred within the first month following diagnosis of AML. The main reason for ICU admission was an acute respiratory disease in 82% of cases. Mechanical ventilation (MV) was required in 57% of patients. In‐ICU mortality was 34%. Among patients discharged alive from ICU, 49% died within a year after discharge. Factors significantly associated with in‐ICU death in multivariate analysis were simplified acute physiology score II and need for invasive MV (IMV). Age, performance status, AML3 subtype and complete remission were significantly associated with 1‐year survival. Patients with acute respiratory failure initially supported with non‐invasive MV had significantly better ICU outcome than patients initially supported with IMV. In conclusion, ICU admission is justified for selected patients with AML. The ICU mortality rate is highly predictable by the acute illness severity score. A 1‐year survival is predicted by haematological prognostic factors.

Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission

“…Poor outcomes have particularly been associated with patients who have had HSCT (especially with myeloablative conditioning) [1][2][3] and patients who required mechanical ventilation [4][5][6]. Although a number of haematology centres from outside the UK have now demonstrated improved outcomes in patients requiring intensive care unit (ICU) support [7,8], the continuing perception of poor outcomes in this patient group may continue to adversely affect their chances of being admitted to some ICUs.…”

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

“…However, these data lead to question the benefit/risk ratio of FOB-BAL in patients with acute myeloid leukemia (AML), in which high mortality rates (450%) have been reported when MV is required. 11,13,14 To confirm our hypothesis that FOB-BAL was probably nonuseful in AML with ARF, as compared to patients with LM, we performed a prospective study to determine the yield and therapeutic impact of FOB-BAL in AML and LM patients with pulmonary infiltrates and ARF requiring intensive care unit admission.…”

Non-invasive mechanical ventilation in hematology patients with hypoxemic acute respiratory failure: a false belief?

“…1 In patients with prolonged neutropenia, respiratory events occur in up to half the cases, of which half are complicated by ARF. 2 Although significantly improved over the last two decades [3][4][5] survival of hematology patients with ARF remains low, especially when mechanical ventilation is needed.…”