title: Characteristics and outcomes of patients with a haematological malignancy admitted to the intensive care unit for a neurological event.
abstract: OBJECTIVE
  Patients with haematological malignancies are at risk of concomitant critical neurological events warranting intensive care unit admission. We aimed to examine the characteristics and outcomes of this patient population, as more knowledge could facilitate decision making on ICU admission and treatment.
  
  
  METHODS
  A retrospective cohort study of 68 patients in adult ICUs of six Dutch university hospitals between 2003 and 2011.
  
  
  RESULTS
  The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23 (IQR, 16-27), and 77% of patients needed mechanical ventilation within the first 24 hours of admission. Forty percent of patients had received an allogeneic stem cell transplantation, and 22% were neutropenic on admission. The most frequent underlying haematological condition was non-Hodgkin lymphoma (27%). Seizures were the most common neurological event for ICU admission (29%). The median ICU length of stay was 5 days (IQR, 1-13 days). ICU mortality (28%), hospital mortality (37%) and 3-month mortality (50%) were comparable with other studies of ICU patients with haematological malignancies. Factors associated with 3-month survival were baseline platelet count (113×10(9)/L in survivors v 39×10(9)/L in non-survivors, P<0.01) and APACHE II score (20 in survivors v 25 in non-survivors, P=0.02).
  
  
  CONCLUSIONS
  Patients with a history of haematological malignancy presenting with a critical neurological event have comparable survival rates with other patients with a haematologic malignancy admitted to the ICU. Our findings suggest that restrictions in ICU care are not justified for this patient population.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.riedijk@amc.nl.
authors.forename: Martiene
authors.initials: M
authors.lastname: Riedijk
authors.affiliation: Department of Critical Care, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Walter M
authors.initials: WM
authors.lastname: van den Bergh
authors.affiliation: Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Vliet
authors.affiliation: Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nuray
authors.initials: N
authors.lastname: Kusadasi
authors.affiliation: Department of Haematology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Lambert R F
authors.initials: LR
authors.lastname: Span
authors.affiliation: Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Tuinman
authors.affiliation: Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M Sesmu
authors.initials: MS
authors.lastname: Arbous
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marcella C A
authors.initials: MC
authors.lastname: Müller
mesh_terms: D018806:APACHE; D003422:Critical Care / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012640:Seizures / Q000150:complications*; D015996:Survival Rate