Intensive Care Medicine

, Volume 36, Issue 10, pp 1744–1750

Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies

  • Dominique M. Vandijck
  • Pieter O. Depuydt
  • Fritz C. Offner
  • Joke Nollet
  • Renaat A. Peleman
  • Eva Steel
  • Lucien A. Noens
  • Johan M. Decruyenaere
  • Dominique D. Benoit
Original

DOI: 10.1007/s00134-010-1903-8

Cite this article as:
Vandijck, D.M., Depuydt, P.O., Offner, F.C. et al. Intensive Care Med (2010) 36: 1744. doi:10.1007/s00134-010-1903-8

Abstract

Purpose

To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality.

Methods

Retrospective analysis of prospectively collected data was performed. Sequential Organ Failure Assessment (SOFA) scores from day 1 to 5 were calculated in all consecutive hematologic malignancy patients admitted to the ICU (2000–2006). Patients were categorized according to the presence or absence, the diagnostic certainty, and the site of BI.

Results

Of the 344 patients admitted, 258 were still in the ICU at day 3 and 164 at day 5. Patients admitted because of BI had more severe OD on day 1 (SOFA 9.7 ± 4.0 vs. 8.4 ± 4.0, p = 0.008) but a more rapidly reversible OD within the first 3 days (ΔSOFA −1.12 ± 3.10 vs. 0.03 ± 3.40, p = 0.013) and a lower in-hospital (43.2% vs. 62.9%, p < 0.001) and 6-month mortality (52.1% vs. 71.7%, p < 0.001) than patients with other complications. In a multivariate analysis, BI remained associated with a lower risk of death (OR 0.20, 95% CI 0.1–0.4, p < 0.001) even after adjustment for the SOFA on day 1 (OR 1.36, 95% CI 1.22–1.52, p < 0.001) and the ΔSOFA (OR 1.48, 95% CI 1.29–1.68, p < 0.001). These findings remained significant regardless of the site and the diagnostic certainty of BI.

Conclusion

BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other complications in ICU patients with hematologic malignancies. These findings further support the recommendation that these patients should certainly benefit from advanced life support, and in the case of an uncertain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial.

Keywords

Admission diagnosis Critically ill Evolution Hematologic malignancy Outcome Sequential Organ Failure Assessment score 

Supplementary material

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(DOC 392 kb)
134_2010_1903_MOESM2_ESM.doc (392 kb)
(DOC 392 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Dominique M. Vandijck
    • 1
    • 2
  • Pieter O. Depuydt
    • 3
  • Fritz C. Offner
    • 4
  • Joke Nollet
    • 3
  • Renaat A. Peleman
    • 2
  • Eva Steel
    • 4
  • Lucien A. Noens
    • 4
  • Johan M. Decruyenaere
    • 3
  • Dominique D. Benoit
    • 3
  1. 1.Department of Public Health and Health Economics, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  2. 2.Department of General Internal Medicine and Infectious DiseasesGhent University HospitalGhentBelgium
  3. 3.Department of Intensive Care MedicineGhent University HospitalGhentBelgium
  4. 4.Department of HematologyGhent University HospitalGhentBelgium