title: Haematological malignancy in the intensive care unit: microbiology results and mortality.
abstract: BACKGROUND
  Mortality prediction models of patients with a haematological malignancy admitted to an intensive care unit (ICU) do not include the presence of neutropenia and microbiology results. We performed a registry-based retrospective study of haematology patients admitted to the ICU to investigate the relation between neutropenia, microbiology results and outcome of these patients.
  
  
  METHODS
  Neutropenia and microbiology culture results within 24 h before or after ICU admission of patients with a haematological malignancy admitted between 2004 and 2010 were described and analysed for association with 28-day mortality.
  
  
  RESULTS
  We identified 234 individual patients with a current malignant haematological condition, of which 27% were neutropenic and 21% had a positive blood culture at admission. Most prevalent from blood cultured species were Escherichia coli and coagulase-negative staphylococci. The overall 28-day mortality was 38%. In patients with a positive blood culture but no neutropenia, 28-day mortality was 28% and in patients with neutropenia but without positive blood culture, it was 36%. The 28-day mortality of patients with both neutropenia and a positive blood culture was 55% with an adjusted (for APACHE-II score) hazard ratio (HR) of 1.8 (95%CI 1.0-3.4) compared to other hematologic patients admitted to the ICU.
  
  
  CONCLUSIONS
  In patients with haematological malignancy admitted to the ICU, culture results are diverse. The combination of neutropenia and positive blood culture is associated with increased 28-day mortality. We suggest this could be of additional value when assessing mortality risk in this patient group.
authors.affiliation: Van Creveldkliniek, University Medical Center, Utrecht, the Netherlands.|Department of Clinical Haematology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Eduard Johannes
authors.initials: EJ
authors.lastname: van Beers
authors.affiliation: Department of Intensive Care Medicine, Medisch Centrum Haaglanden, The Hague, the Netherlands.|Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marcella Catharina Antoinetta
authors.initials: MC
authors.lastname: Müller
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Alexander Petrus Johannes
authors.initials: AP
authors.lastname: Vlaar
authors.affiliation: Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.affiliation: Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Walter Marcel
authors.initials: WM
authors.lastname: van den Bergh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands; D009503:Neutropenia / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index
keywords: haematological malignancy; intensive care unit; microbiological culture; mortality; neutropenia