Intensive care unit outcomes in patients with hematological malignancy

Abstract

Hematological malignancies are usually life-limiting conditions. Limitations of care need to be decided early, based on acceptability to the patient, family, physician, and community. Inappropriate intensive care unit (ICU) admission is likely to result in significant physical, psychological, and economic burden. There is little published on the impact of non-acute preadmission disease factors on ICU outcomes in hematological malignancies.

Aim: To identify baseline performance and disease-associated factors before admission to ICU in patients with hematological malignancy that contribute to subsequent ICU mortality.

Methods: A retrospective analysis of electronic medical records, laboratory results, and Intensive Care data for all patients (n = 184) with hematological malignancy admitted to the Calvary Mater Hospital ICU between January 1, 2013 and June 30, 2017 was undertaken. Baseline age, gender, condition, Eastern Cooperative Oncology, and Charlson Comorbidity scores were compared to ICU outcome and overall survival. Disease-specific prognostic risk scores were compared to ICU outcome.

Results: Overall, 73.9% survived the ICU admission, with 31.6% surviving at 12 months. Superior ejection fractions (>55%) and prognosis >12 months (based on disease-specific risk scores) were significantly associated with overall survival (P = 0.024 and P = 0.001). Induction and posttransplantation therapy were predictive of poor ICU survival outcome (P < 0.0001 and P = 0.041). APACHE scores were significant predictors of ICU mortality (P = 0.002 for APACHE II and P < 0.0001 for APACHE III).

Conclusion: Survival outcomes for patients with hematological malignancy admitted to the ICU correlate with functional and comorbidity status. Disease-specific prognostic scores can assist in recognizing patients likely to benefit from ICU admission.

Keywords: Comorbidity; Hematologic malignancy; Intensive care; Prognosis.