Resource use and outcome in critically ill patients with hematological malignancy: a retrospective cohort study.
BACKGROUND
The paucity of data on resource use in critically ill patients with hematological malignancy and on these patients' perceived poor outcome can lead to uncertainty over the extent to which intensive care treatment is appropriate. The aim of the present study was to assess the amount of intensive care resources needed for, and the effect of treatment of, hemato-oncological patients in the intensive care unit (ICU) in comparison with a nononcological patient population with a similar degree of organ dysfunction.


METHODS
A retrospective cohort study of 101 ICU admissions of 84 consecutive hemato-oncological patients and 3,808 ICU admissions of 3,478 nononcological patients over a period of 4 years was performed.


RESULTS
As assessed by Therapeutic Intervention Scoring System points, resource use was higher in hemato-oncological patients than in nononcological patients (median (interquartile range), 214 (102 to 642) versus 95 (54 to 224), P < 0.0001). Severity of disease at ICU admission was a less important predictor of ICU resource use than necessity for specific treatment modalities. Hemato-oncological patients and nononcological patients with similar admission Simplified Acute Physiology Score scores had the same ICU mortality. In hemato-oncological patients, improvement of organ function within the first 48 hours of the ICU stay was the best predictor of 28-day survival.


CONCLUSIONS
The presence of a hemato-oncological disease per se is associated with higher ICU resource use, but not with increased mortality. If withdrawal of treatment is considered, this decision should not be based on admission parameters but rather on the evolutional changes in organ dysfunctions.
Department of Intensive Care Medicine, Royal North Shore Hospital of Sydney, University of Sydney, St Leonards, 2065 NSW, Australia. tobias.merz@bluewin.ch
Tobias M
TM
Merz
Pascale
P
Schär
Michael
M
Bühlmann
Jukka
J
Takala
Hans U
HU
Rothen
D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology