Survival of patients with hematological malignancy admitted to the intensive care unit: prognostic factors and outcome compared to unselected medical intensive care unit admissions, a parallel group study

Hill, Quentin A.; Kelly, Richard; Patalappa, Chetan; Whittle, Annika M.; Scally, Andy J.; Hughes, Anthony; Ashcroft, A. John; Hill, Anita

doi:10.3109/10428194.2011.614705

Cited by 31 publications

(21 citation statements)

References 48 publications

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“…25,30 Uchino et al reported increased mortality rates in a multicenter and multinational study on CF patients requiring RRT. 31 The requirement for RRT in CF patients in our study was associated with increased mortality similar to the literature.…”

Section: Resultssupporting

confidence: 87%

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

2016

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Section: Resultssupporting

confidence: 87%

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

2016

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“…APACHE II is the most accurate score in this group of patients [2]; however it may still underestimate mortality in HM patients [1]. In a study comparing patients with HM to medical critical care patients, outcomes in patients with HM were significantly worse, with only 27% of patients with HM surviving to hospital discharge [20]. However, in another study comparing patients with a similar SAPS II score, there was no significant difference in outcome [21].…”

Section: Introductionmentioning

confidence: 99%

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Hampshire¹,

Pugh²,

Hajimichael³

2014

J Cancer Ther Res

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Background: Patients with haematological malignancies admitted to critical care units have a high mortality. Specialist cancer centres may demonstrate better survival rates than non-specialist centres. We compared the outcomes of patients with haematological malignancies admitted to three different centres in the United Kingdom, and examined possible reasons for differences in outcomes. Methods: We compared the characteristics and outcomes of patients with haematological malignancies admitted to critical care units at the Christie, Royal Liverpool University and Glan Clwyd hospitals between 1st January 2007 and 1st July 2011. Differences between hospitals were compared using ANOVA or Chi-squared test, as appropriate. Factors associated with hospital mortality were analysed using logistic regression analysis. Results: 187 patients with haematological malignancies were identified. More patients with Hodgkin's lymphoma were admitted to Glan Clwyd hospital (25%) compared to Royal Liverpool (5.8%) and the Christie (8.1%), p=0.0087. Patients admitted to the Christie had lower severity-of-illness scores compared to patients admitted to the other hospitals (p<0.001). Overall, 91 patients died before hospital discharge (48.7%). Unadjusted hospital mortality at the Christie was significantly lower (41.4%), compared to the Royal Liverpool (61.5%) and Glan Clwyd hospitals (54.2%), p=0.0240. On logistic regression analysis, the only factor associated with higher odds of hospital mortality was increasing APACHE II score (p=0.035, odds ratio 1.06 [95% CI 1.04-1.13] per point). Admission to a non-specialist centre was associated with higher odds of critical care unit mortality (p=0.036, odds ratio 2.17 [95% CI 1.05-4.46]), but was not associated with higher odds of hospital mortality (p=0.065). Conclusions: Admission to a specialist centre was not associated with lower hospital mortality compared to non-specialist centres for patients with haematological malignancies. However, admission to a specialist centre was associated with lower critical care unit mortality. Possible explanations for these differences in survival between centres could be the identified significant differences in casemix, or lower severity of illness at admission. In addition the severity of illness on admission to the critical care unit as indicated by the APACHE II score increased the odds of hospital mortality.

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“…12 Once patients are admitted to the ICU, infectious processes, the need for mechanical ventilation, and inotropic support were shown to independently predict poor outcomes. 13,14 Maddocks and colleagues found that patients with hematological malignancies more often died in acute care versus palliative care settings, and the cause of death was an acute event such as hemorrhage or sepsis. 15 Similarly, a significant portion of patients with leukemia and lymphoma who were admitted to the ICU in our study had a diagnosis of sepsis (60%), and 20% had a diagnosis of acute hemorrhage.…”

Section: Discussionmentioning

confidence: 97%

“…Death in the hospital without ICU services was the referent group. Candidate variables were entered into a backward elimination multinomial logistic regression analysis for the probability of 13.9% died in the hospital following an ICU stay, and 44.2% died in the hospital without ICU services. The average age (standard deviation) of decedents was 57.6 (15.9), 57% were male, 60% had solid tumors, and 40% had hematologic malignancies.…”

Section: Discussionmentioning

confidence: 99%

Place of Death among Hospitalized Patients with Cancer at the End of Life

Wallace

Waller

Tilley

et al. 2015

Journal of Palliative Medicine

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Understanding existing patterns of care at the end of life will help guide decisions about resource allocation and palliative care programs. Patients who seek care at dedicated cancer centers may elect more aggressive care; thus the generalizability of this study is limited. Although dying in a hospital may be unavoidable for patients who have uncontrolled symptoms that cannot be managed at home, palliative care consultations with patients and their families in advance regarding end-of-life preferences may prevent unwanted admission to the ICU.

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Survival of patients with hematological malignancy admitted to the intensive care unit: prognostic factors and outcome compared to unselected medical intensive care unit admissions, a parallel group study

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Cited by 31 publications

References 48 publications

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom

Place of Death among Hospitalized Patients with Cancer at the End of Life

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