title: Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit.
abstract: Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22-33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01-1.38) and invasive ventilation (OR 9.64, 95% CI 3.39-27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5.
authors.forename: Alan P
authors.identifier: 0000-0001-7948-093X
authors.initials: AP
authors.lastname: Kraguljac
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5.
authors.forename: Danielle
authors.initials: D
authors.lastname: Croucher
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5; Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Michael
authors.initials: M
authors.lastname: Christian
authors.affiliation: Division of Medical Oncology & Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada M5G 2M9.
authors.forename: Narmin
authors.initials: N
authors.lastname: Ibrahimova
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5.
authors.forename: Vikram
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Jacob
authors.affiliation: Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5.
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8; Division of Medical Oncology & Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada M5G 2M9.
authors.forename: Mark D
authors.identifier: 0000-0002-9089-8816
authors.initials: MD
authors.lastname: Minden
authors.affiliation: Department of Medicine & Interdepartmental Division of Critical Care, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5; Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Sangeeta
authors.identifier: 0000-0002-7073-4769
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D012189:Retrospective Studies