Time trend analysis of long term outcome of patients with haematological malignancies admitted at dutch intensive care units

Abstract

A few decades ago, the chances of survival for patients with a haematological malignancy needing Intensive Care Unit (ICU) support were minimal. As a consequence, ICU admission policy was cautious. We hypothesized that the long-term outcome of patients with a haematological malignancy admitted to the ICU has improved in recent years. Furthermore, our objective was to evaluate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE) II score. A total of 1095 patients from 5 Dutch university hospitals were included from 2003 until 2015. We studied the prevalence of patients' characteristics over time. By using annual odds ratios, we analysed which patients' characteristics could have had influenced possible trends in time. A approximated mortality rate was compared with the ICU mortality rate, to study the predictive value of the APACHE II score. Overall one-year mortality was 62%. The annual decrease in one-year mortality was 7%, whereas the APACHE II score increased over time. Decreased mortality rates were particularly observed in high-risk patients (acute myeloid leukaemia, old age, low platelet count, bleeding as admission reason and need for mechanical ventilation within 24 h of ICU admission). Furthermore, the APACHE II score overestimates mortality in this patient category.

One-year survival of patients with high-grade glioma discharged alive from the intensive care unit

“…Indeed, considering the median time between cancer diagnosis and ICU admission [6 (2–20) months] and considering the median survival of patients with HGG [ 14 ], the 27% survival after ICU admission observed in this study appears to be substantial and encouraging. Moreover, the survival rate 1 year after ICU admission was fairly similar to that observed in patients with other types of solid cancer [ 2 , 11 , 26 – 29 ] or hematologic malignancies [ 30 – 34 ]. Young age, limited comorbidities, and a high proportion of rapidly reversible causes, such as seizures, could explain this relatively high 1-year survival rate.…”

Long-Term Mortality Among ICU Patients With Stroke Compared With Other Critically Ill Patients

“…The 1-year mortality rate of 41% in IS and 51% in ICH patients admitted to the ICU found in this study is comparable to earlier studies (10)(11)(12)(13)(14)(15)(28)(29)(30), although previous literature did not report mortality beyond one year after ICU admission in such a large cohort. Furthermore, the present study did not only compare stroke patients to other neurologic ICU patients (12)(13)(14) but also included cardiac surgery patients with low predicted mortality and patients with diagnoses suspected for long-term sequelae and high predicted mortality, such as ICU patients with sepsis, sCAP, and nonsurgical cancer (31). This has led to the observation that long-term mortality in critically ill stroke patients is higher than in TBI or SAH, as shown earlier (12)(13)(14) and that the survival patterns of patients with sepsis and sCAP is totally different from stroke patients.…”

Medical resource utilization patterns and mortality rates according to age among critically ill patients admitted to a medical intensive care unit

“…Moreover, hematologic malignancies were significantly associated with the 28-day ICU mortality (HR 1.367, after adjusting other confounding variables). Considering the poor short- and long-term outcomes among patients with hematologic malignancies admitted to ICU, [26] the presence of hematologic malignancies at baseline might have contributed to the higher 28-day ICU mortality rate for the young-elderly group and support the suggestion that differences in baseline characteristics need to be considered when assessing ICU outcomes. [27]…”