Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome.
OBJECTIVE
To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies.


METHODS
Prospective observational study in a 14-bed medical ICU at a tertiary university hospital.


METHODS
A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels.


RESULTS
In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications.


CONCLUSIONS
Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.
Benoit
Dominique D
DD
Department of Intensive Care, Medical Intensive Care Unit, 12K12IB, De Pintelaan 185, 9000, Ghent, Belgium. dominique.benoit@Ugent.be
Depuydt
Pieter O
PO
Peleman
Renaat A
RA
Offner
Fritz C
FC
Vandewoude
Koenraad H
KH
Vogelaers
Dirk P
DP
Blot
Stijn I
SI
Noens
Lucien A
LA
Colardyn
Francis A
FA
Decruyenaere
Johan M
JM
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D004282:Documentation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007938:Leukemia / Q000150:complications*; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index