title: Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis.
abstract: Although the overall mortality of patients admitted to intensive care units (ICU) with hematological malignancy has decreased over the years, some groups of patients still have low survival rates. We performed a monocentric retrospective study including all patients with hematological malignancy in a ten-year period, to identify factors related to the outcome for the whole cohort and for patients with allogeneic hematopoietic stem cell transplantation (HSCT), neutropenia, or those requiring invasive mechanical ventilation (IMV). A total of 418 patients with acute leukemia (n=239; 57%), myeloma (n=69; 17%), and lymphoma (n=53; 13%) were studied. Day-28 and 1-year mortality were 49% and 72%, respectively. The type of disease was not associated with outcome. The disease status was independentlty associated with 1-year mortality only. Independent predictors of day-28 mortality were IMV, renal replacement therapy (RRT), and performance status. For allogeneic HSCT recipients (n=116), neutropenic patients (n=124) and patients requiring IMV (n=196), day-28 and 1-year mortality were 52%, 54%, 74% and 81%, 78%, 87%, respectively. Multivariate analysis showed that IMV and RRT for allogeneic HSCT recipients, performance status and IMV for neutropenic patients, and RRT for patients requiring IMV were independently associated with short-term mortality (p<0.05).These results suggest that IMV is the strongest predictor of mortality in hematological patients admitted to ICUs, whereas allogeneic HSCT and neutropenia do not worsen their short-term outcome.
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.|Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Faucher
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.|Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Cour
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.|Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jahandiez
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Grateau
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baudry
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Hernu
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Simon
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Robert
authors.affiliation: Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France.|Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service d'hématologie, F-69310, Pierre-Bénite, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France.|Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: allogeneic hematopoietic stem cell transplantation; hematological malignancy; intensive care unit; invasive mechanical ventilation; neutropenia