Predictors of short and long-term outcome in patients with hematological disorders admitted to the intensive care unit for a life-threatening complication.
OBJECTIVE
The admission of patients with hematological disorders to the intensive care unit (ICU) involves a complex resource usage and may be associated with high mortality. The decision making to transfer a severely ill patient to the ICU, therefore, presents an ethical dilemma. We assessed both early and long-term outcomes in relation to clinical characteristics with the aim to facilitate clinical decision making.


METHODS
We performed a cohort study of hematological patients admitted to ICU at a university hospital.


RESULTS
During a 6-year period (1996-2001), 85 patients with a median age of 59 years were admitted to ICU. The majority of patients (88%) suffered from hematological malignancies. Major reasons for ICU admission were respiratory failure (41%) and septic shock/pre-shock (24%). The median duration of ICU admission was 2 (1-67) days. Crude in-ICU, 30-day, and 6-month mortality rates were 30, 49, and 62%, respectively. Overall 5-year survival rate was 20%, and 13 (15%) patients were alive at time of follow-up (median 7.4 years). Respiratory failure requiring ventilatory support and a high Acute Physiology and Chronic Health Evaluation II score was significantly correlated to high in-ICU mortality, but not to long-term outcome. Type of hematological malignancy, neutropenia, thrombocytopenia, bacteremia, prior administration of chemotherapy, age, or gender was not significantly associated with outcome.


CONCLUSIONS
The current study provides encouraging results on long-term post-ICU outcome also in elderly patients with hematological diseases. For a substantial proportion of critically ill hematological patients, a short time care at an ICU is lifesaving. These patients should be offered intensive care unless or until it is clear that there is little prospect of recovery from the acute illness or that the underlying malignancy cannot be controlled.
Cherif
Honar
H
Division of Haematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. honar.cherif@karolinska.se
Martling
Claes-Roland
CR
Hansen
Jan
J
Kalin
Mats
M
Björkholm
Magnus
M
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D005260:Female; D006402:Hematologic Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome