Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis
Résumé
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\textless0.05).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.
Mots clés
Hematopoietic Stem Cell Transplantation/adverse effects
hematological malignancy
Hematologic Neoplasms/complications/*mortality/therapy
intensive care unit
Intensive Care Units/*statistics & numerical data
Adult
Female
Humans
Male
Retrospective Studies
Aged
Middle Aged
Risk Factors
Treatment Outcome
Kaplan-Meier Estimate
Respiration
Artificial/adverse effects
allogeneic hematopoietic stem cell transplantation
Allografts
invasive mechanical ventilation
neutropenia
Neutropenia/complications