Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study

Laveena Munshi; Guillaume Dumas; Bram Rochwerg; Farah Shoukat; Michael Detsky; Dean A Fergusson; Bruno L Ferreyro; Paul Heffernan; Margaret Herridge; Sheldon Magder; Mark Minden; Rakesh Patel; Salman Qureshi; Aaron Schimmer; Santhosh Thyagu; Han Ting Wang; Sangeeta Mehta

doi:10.1007/s00134-024-07349-z

Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study

Intensive Care Med. 2024 Apr;50(4):561-572. doi: 10.1007/s00134-024-07349-z. Epub 2024 Mar 11.

Authors

Laveena Munshi^{1

2}, Guillaume Dumas³, Bram Rochwerg^{4

5}, Farah Shoukat⁶, Michael Detsky⁶, Dean A Fergusson^{7

8}, Bruno L Ferreyro^{6

9}, Paul Heffernan¹⁰, Margaret Herridge¹¹, Sheldon Magder^{12

13}, Mark Minden¹⁴, Rakesh Patel^{15

16}, Salman Qureshi¹⁷, Aaron Schimmer¹⁴, Santhosh Thyagu¹⁴, Han Ting Wang¹⁸, Sangeeta Mehta⁶

Affiliations

¹ Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. Laveena.munshi@sinaihealth.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Laveena.munshi@sinaihealth.ca.
³ Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France.
⁴ Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada.
⁵ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
⁶ Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁸ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
¹⁰ Department of Medicine at Queen's University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
¹¹ Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
¹² Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
¹³ Critical Care Department, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
¹⁴ Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
¹⁵ Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁶ Department of Critical Care Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁷ Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
¹⁸ Division of Critical Care MedicineDepartment of Medicine at Hopital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.

PMID: 38466402
DOI: 10.1007/s00134-024-07349-z

Abstract

Purpose: Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described.

Methods: We conducted a prospective, observational study of HM patients admitted to seven Canadian intensive care units (ICUs) (2018-2020). We followed survivors at 7 days, 6 months and 12 months following ICU discharge. The primary outcome was 12-month survival. We evaluated functional outcomes at 6 and 12 months using the functional independent measure (FIM) and short form (SF)-36 as well as variables associated with 12-month survival.

Results: We enrolled 414 patients including 35% women. The median age was 61 (interquartile range, IQR: 52-69), median Sequential Organ Failure Assessment (SOFA) score was 9 (IQR: 6-12), and 22% had moderate-severe frailty (clinical frailty scale [CFS] ≥ 6). 51% had acute leukemia, 38% lymphoma/multiple myeloma, and 40% had received a hematopoietic stem cell transplant (HCT). The most common reasons for ICU admission were acute respiratory failure (50%) and sepsis (40%). Overall, 203 (49%) were alive 7 days post-ICU discharge (ICU survivors). Twelve-month survival of the entire cohort was 21% (43% across ICU survivors). The proportion of survivors with moderate-severe frailty was 42% (at 7 days), 14% (6 months), and 8% (12 months). Median FIM at 7 days was 80 (IQR: 50-109). Physical function, pain, social function, mental health, and emotional well-being were below age- and sex-matched population scores at 6 and 12 months. Frailty, allogeneic HCT, kidney injury, and cardiac complications during ICU were associated with lower 12- month survival.

Conclusions: 49% of all HM patients were alive at 7 days post-ICU discharge, and 21% at 12 months. Survival varied based upon hematologic diagnosis and frailty status. Survivors had important functional disability and impairment in emotional, physical, and general well-being.

Keywords: Hematologic malignancy; Immunocompromised; Long-term outcomes.

Publication types

Observational Study
Multicenter Study

MeSH terms

Canada / epidemiology
Critical Illness
Female
Frailty* / diagnosis
Hematologic Neoplasms*
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies

Grants and funding

001/Leukemia and Lymphoma Society of Canada