title: Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction.
abstract: This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU.
  
  
  
  Multivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operator characteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of ≥25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge.
  
  
  
  Our data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit from intensive care.
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Michele
authors: M
authors: Pohlen
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Nils H
authors: NH
authors: Thoennissen
authors: Department of Medicine III, Hematology and Oncology, University Hospital Grosshadern, Munich, Germany.
authors: Jan
authors: J
authors: Braess
authors: Department of Medicine III, Hematology and Oncology, University Hospital Grosshadern, Munich, Germany.
authors: Johannes
authors: J
authors: Thudium
authors: Department of Medicine II, Klinikum Augsburg, Augsburg, Germany.
authors: Christoph
authors: C
authors: Schmid
authors: Department of Medicine I, University Hospital Cologne, Cologne, Germany.
authors: Matthias
authors: M
authors: Kochanek
authors: Department of Medicine I, University Hospital Cologne, Cologne, Germany.
authors: Karl-Anton
authors: KA
authors: Kreuzer
authors: Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Pia
authors: P
authors: Lebiedz
authors: Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany.
authors: Dennis
authors: D
authors: Görlich
authors: Department of Medicine D, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Hans U
authors: HU
authors: Gerth
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Christian
authors: C
authors: Rohde
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Torsten
authors: T
authors: Kessler
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Carsten
authors: C
authors: Müller-Tidow
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Matthias
authors: M
authors: Stelljes
authors: Carsten
authors: C
authors: Hullermann
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Thomas
authors: T
authors: Büchner
authors: Department of Medicine II, Klinikum Augsburg, Augsburg, Germany.
authors: Günter
authors: G
authors: Schlimok
authors: Department of Medicine I, University Hospital Cologne, Cologne, Germany.
authors: Michael
authors: M
authors: Hallek
authors: Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Johannes
authors: J
authors: Waltenberger
authors: Department of Medicine III, Hematology and Oncology, University Hospital Grosshadern, Munich, Germany.
authors: Wolfgang
authors: W
authors: Hiddemann
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Wolfgang E
authors: WE
authors: Berdel
authors: Department of Medicine II, Klinikum Augsburg, Augsburg, Germany.
authors: Bernhard
authors: B
authors: Heilmeier
authors: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors: Utz
authors: U
authors: Krug
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D012189:Retrospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology*; D062606:Tertiary Care Centers; D055815:Young Adult