Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies.
OBJECTIVE
To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality.


METHODS
Retrospective analysis of prospectively collected data was performed. Sequential Organ Failure Assessment (SOFA) scores from day 1 to 5 were calculated in all consecutive hematologic malignancy patients admitted to the ICU (2000-2006). Patients were categorized according to the presence or absence, the diagnostic certainty, and the site of BI.


RESULTS
Of the 344 patients admitted, 258 were still in the ICU at day 3 and 164 at day 5. Patients admitted because of BI had more severe OD on day 1 (SOFA 9.7 ± 4.0 vs. 8.4 ± 4.0, p = 0.008) but a more rapidly reversible OD within the first 3 days (ΔSOFA -1.12 ± 3.10 vs. 0.03 ± 3.40, p = 0.013) and a lower in-hospital (43.2% vs. 62.9%, p < 0.001) and 6-month mortality (52.1% vs. 71.7%, p < 0.001) than patients with other complications. In a multivariate analysis, BI remained associated with a lower risk of death (OR 0.20, 95% CI 0.1-0.4, p < 0.001) even after adjustment for the SOFA on day 1 (OR 1.36, 95% CI 1.22-1.52, p < 0.001) and the ΔSOFA (OR 1.48, 95% CI 1.29-1.68, p < 0.001). These findings remained significant regardless of the site and the diagnostic certainty of BI.


CONCLUSIONS
BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other complications in ICU patients with hematologic malignancies. These findings further support the recommendation that these patients should certainly benefit from advanced life support, and in the case of an uncertain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial.
Vandijck
Dominique M
DM
Department of Public Health and Health Economics, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. Dominique.Vandijck@UGent.be.|Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. Dominique.Vandijck@UGent.be.
Depuydt
Pieter O
PO
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Offner
Fritz C
FC
Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Nollet
Joke
J
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Peleman
Renaat A
RA
Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Steel
Eva
E
Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Noens
Lucien A
LA
Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Decruyenaere
Johan M
JM
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Benoit
Dominique D
DD
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000503:physiopathology; D016001:Confidence Intervals; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve