title: Prognosis of hematologic malignancies does not predict intensive care unit mortality.
abstract: OBJECTIVE
  To evaluate the correlation between specific prognosis of hematologic malignancies on the one hand and intensive care unit and hospital mortality in critically ill patients with hematologic malignancies on the other hand.
  
  
  METHODS
  Observational study during a 10-yr period.
  
  
  METHODS
  A 22-bed medical-surgical intensive care unit.
  
  
  METHODS
  A total of 84 consecutive patients with nonterminal hematologic malignancies with medical complications requiring intensive care.
  
  
  METHODS
  None.
  
  
  METHODS
  Demographic factors, acute physiology and organ dysfunction scores, microbiology, therapeutic support, and hematologic factors data on admission and during the intensive care unit stay were collected, together with mortality follow-up. Based on specific-disease prognostic factors and related published survival curves, the prognosis of hematologic malignancies was assessed and defined as good, intermediate, or poor according to a 3-yr survival probability of >50%, 20-50%, or <20%, respectively.
  
  
  RESULTS
  Prognosis of hematologic malignancies does not predict intensive care unit or hospital mortality and almost reaches significance for 6-mo mortality (53%, 71%, and 84% rate for patients with good, intermediate, and poor prognosis, respectively, p =.058), but it determines long-term survival (p =.008). Intensive care unit, hospital, and 6-mo overall mortality rates were 38%, 61%, and 75%, respectively. Using multivariate analysis, intensive care unit mortality was best predicted on admission by respiratory failure and fungal infection, whereas hospital mortality was predicted by the number of organ failures, the bone marrow transplant status, and the presence of fungal infection. The Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II had no prognostic value, whereas the difference of the Multiple Organ Dysfunction Score between at the time of admission and at day 5 allowed quick prediction of hospital mortality. Diseases with the poorest 6-mo prognosis were acute myeloid leukemia and non-Hodgkin lymphoma. CONCLUSION The severity of the underlying hematologic malignancies does not influence intensive care unit or hospital mortality. Short-term prognosis is exclusively predicted by acute organ dysfunctions and by a pathogen's aggressiveness. Therefore, reluctance to admit patients with nonterminal hematologic malignancies to the intensive care unit based only on the prognosis of their underlying hematologic malignancy does not seem justified.
authors.affiliation: Department of Critial Care Medicine, Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Massion
authors.forename: Alain M
authors.initials: AM
authors.lastname: Dive
authors.forename: Chantal
authors.initials: C
authors.lastname: Doyen
authors.forename: Pierre
authors.initials: P
authors.lastname: Bulpa
authors.forename: Jacques
authors.initials: J
authors.lastname: Jamart
authors.forename: André
authors.initials: A
authors.lastname: Bosly
authors.forename: Etienne
authors.initials: E
authors.lastname: Installé
mesh_terms: D018806:APACHE; D000328:Adult; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis