Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis
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Etienne Faucher1,2, Martin Cour1,2, Vincent Jahandiez1,2, Adeline Grateau1, Thomas Baudry1, Romain Hernu1, Marie Simon1, Jean-michel Robert1, Mauricette Michallet2,3, Laurent Argaud1,2
1Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de réanimation médicale, F-69003, Lyon, France
2Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, F-69008, Lyon, France
3Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service d’hématologie, F-69310, Pierre-Bénite, France
Laurent Argaud, e-mail: [email protected]
Keywords: hematological malignancy, allogeneic hematopoietic stem cell transplantation, neutropenia, invasive mechanical ventilation, intensive care unit
Received: October 29, 2016 Accepted: February 23, 2016 Published: March 8, 2016
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.
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