Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality.
BACKGROUND
The prognosis of patients with haematological malignancies who are admitted to the ICU is generally poor. In order to optimize care, it is important to be able to determine which patients are most likely to benefit from continuation of treatment after ICU admission.


METHODS
Data of 86 patients with a haematological malignancy consecutively admitted to the ICU of Maastricht University Medical Centre were examined in a retrospective cohort study in order to identify clinically useful prognostic parameters.


RESULTS
ICU mortality was 56% and in-hospital mortality was 65%. Non-survivors had higher APACHE-II and SOFA scores compared with survivors (32±8.0 versus 25±6.5 and 11.5±3.1 versus 8.5±3.0, respectively). The mortality rate was significantly higher in patients with an increasing SOFA score (≥2 points) compared with patients with an unchanged or decreasing SOFA score (72% versus 58% and 21%, respectively). Mortality was also higher in patients requiring invasive mechanical ventilation or inotropic/vasopressor therapy.


CONCLUSIONS
The mortality rate among patients with haematological malignancies who are admitted to the ICU is high and mainly associated with the severity of illness, as reflected by more severe and worsening organ failure and a need for mechanical ventilation or inotropic/vasopressor therapy. Several factors appear to be associated with a poor outcome, but no absolute predictors of mortality could be identified, although the results suggest that changes in the SOFA score during the stay in the ICU can be helpful in the decision making about the continuation or discontinuation of treatment.
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Daniël A
DA
Geerse
Lambert F R
LF
Span
Sara-Joan
SJ
Pinto-Sietsma
Walther N K A
WN
van Mook
D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate