Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: a single-center experience.
Patients who are admitted to the intensive care unit (ICU) with hematologic malignancies have a poor prognosis, although outcomes have improved in recent years. This study analyzed ICU mortality, short- and long-term survival, and prognostic factors for 100 consecutive critically ill patients with a hematologic malignancy who were admitted to our polyvalent ICU from January 2000 to May 2006. The median age was 55 years (range, 15-75 years; male-female ratio, 60:40). The main acute life-threatening diseases precipitating ICU transfer were respiratory failure (45 patients, 45%) and septic shock (33 patients, 33%). Forty-two patients (42%) were discharged from the ICU. The ICU mortality rate from 2004 to 2006 was lower than from 2000 to 2003 (49% versus 69%, P < .047). The 1- and 2-year probabilities of survival for patients discharged from the ICU were 67% (95% confidence interval [CI], 51%-84%) and 54% (95% CI, 34%-73%), respectively. A multivariate analysis revealed hemodynamic instability (odds ratio, 2.11; 95% CI, 1.17-3.83; P = .014) and mechanical ventilation (odds ratio, 4.27; 95% CI, 1.70-10.74; P = .002) to be the main predictors of a poor survival prognosis. Almost half of patients with hematologic malignancy and life-threatening complications can be discharged from the ICU. Age and underlying disease characteristics do not influence ICU outcome, which is mainly determined by hemodynamic and ventilatory status.
Ferrà
Christelle
C
Clinical Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Universitat Autónoma de Barcelona, Spain.
Marcos
Pilar
P
Misis
Maite
M
Morgades
Mireia
M
Bordejé
María-Luisa
ML
Oriol
Albert
A
Lloveras
Natalia
N
Sancho
Juan-Manuel
JM
Xicoy
Blanca
B
Batlle
Montserrat
M
Klamburg
Jordi
J
Feliu
Evarist
E
Ribera
Josep-Maria
JM
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality; D012772:Shock, Septic / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D017741:Survivors; D016896:Treatment Outcome