Risk Factors and Outcomes in Critically Ill Patients with Hematological Malignancies Complicated by Hospital-Acquired Infections

Abstract

Background and objectives: Patients admitted to the intensive care unit (ICU) have an increased risk of hospital-acquired infection (HAI). A diagnosis of cancer alone increases the risk of sepsis three–five-fold, which further increases the risk of nosocomial infection, subsequently deteriorates results, and leads to high mortality. In this study, we aimed to assess the mortality rate among hematologic oncologic patients with suspected infection who were subsequently admitted to the ICU and the predictive factors that are associated with high ICU mortality. Materials and Methods: This retrospective cohort study was conducted in the hematological oncology critical care unit of a tertiary care hospital between November 2017 and February 2021. We analyzed anonymized medical records of hospitalized hematologic oncologic patients who were suspected or proven to have infection in the hematology-oncology department and were subsequently transferred to the ICU. Results: Both shorter hospitalization and shorter ICU stay length were observed in survivors [9.2 (7.7–10.4)] vs. non-survivors [10 (9.1–12.9), p = 0.004]. Sepsis had the highest hazard ratio (7.38) among all other factors, as patients with sepsis had higher mortality rates (98% among ICU non-survivors and 57% among ICU survivors) than those who had febrile neutropenia. Conclusions: The overall ICU mortality in patients with hematologic malignancies was 66%. Sepsis had the highest hazard ratio among all other predictive factors, as patients with sepsis had higher mortality rates than those who had febrile neutropenia. Chronic hepatitis (HBV and HCV) was significantly associated with higher ICU mortality.

Continuous renal replacement therapy with oXiris® in patients with hematologically malignant septic shock: A retrospective study

“…Patients admitted to the ICU are at increased risk of developing hospital-acquired infection. A diagnosis of cancer alone increases the risk of sepsis by 3–5-fold, which further increases the risk of nosocomial infection, subsequently deteriorating results and leading to high mortality[ 5 ]. Therefore, it is particularly valuable for immunocompromised patients.…”

“…It is useful to consider different phases of fluid management in patients with septic shock over the course of acute illness, which are the resuscitation, optimization, stabilization, and evacuation phases[ 4 ]. However, patients with HM admitted to the intensive care unit (ICU) have an increased risk of hospital-acquired infection, which can deteriorate the patient’s condition and lead to high mortality[ 5 ]. Shortening the resuscitation period, and therefore, shortening the time spent in the ICU by safely adjusting the fluid balance with continuous renal replacement therapy (CRRT) would be an attractive strategy, especially for such patients.…”