title: Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study.
abstract: PURPOSE Patients with hematologic malignancies are increasingly admitted to the intensive care unit (ICU) when life-threatening events occur. We sought to report outcomes and prognostic factors in these patients. PATIENTS AND METHODS Ours was a prospective, multicenter cohort study of critically ill patients with hematologic malignancies. Health-related quality of life (HRQOL) and disease status were collected after 3 to 6 months. Results Of the 1,011 patients, 38.2% had newly diagnosed malignancies, 23.1% were in remission, and 24.9% had received hematopoietic stem-cell transplantations (HSCT, including 145 allogeneic). ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%). On day1, 733 patients (72.5%) received life-supporting interventions. Hospital, day-90, and 1-year survival rates were 60.7%, 52.5%, and 43.3%, respectively. By multivariate analysis, cancer remission and time to ICU admission less than 24 hours were associated with better hospital survival. Poor performance status, Charlson comorbidity index, allogeneic HSCT, organ dysfunction score, cardiac arrest, acute respiratory failure, malignant organ infiltration, and invasive aspergillosis were associated with higher hospital mortality. Mechanical ventilation (47.9% of patients), vasoactive drugs (51.2%), and dialysis (25.9%) were associated with mortality rates of 60.5%, 57.5%, and 59.2%, respectively. On day 90, 80% of survivors had no HRQOL alterations (physical and mental health similar to that of the overall cancer population). After 6 months, 80% of survivors had no change in treatment intensity compared with similar patients not admitted to the ICU, and 80% were in remission. CONCLUSION Critically ill patients with hematologic malignancies have good survival, disease control, and post-ICU HRQOL. Earlier ICU admission is associated with better survival.
authors.affiliation: Hôpital Saint-Louis, Medical ICU, Paris, France. elie.azoulay@sls.aphp.fr
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lambert
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Martine
authors.initials: M
authors.lastname: Nyunga
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Louise-Marie
authors.initials: LM
authors.lastname: Laisne
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.forename: Christine
authors.initials: C
authors.lastname: Lebert
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.forename: Marine
authors.initials: M
authors.lastname: Chaize
authors.forename: Anne
authors.initials: A
authors.lastname: Renault
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hamidfar
authors.forename: Mercé
authors.initials: M
authors.lastname: Jourdain
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Benoit
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
mesh_terms: D000368:Aged; D001530:Belgium; D016638:Critical Illness; D005260:Female; D005602:France; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000523:psychology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life