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

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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.

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Data availability

For data inquiries, please contact corresponding author.

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Funding

This study was funded by a grant from the Leukemia and Lymphoma Society of Canada and the MSH/UHN AMO Innovation Fund.

Author information

Authors and 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, Farah Shoukat, Michael Detsky, Bruno L. Ferreyro & Sangeeta Mehta

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Laveena Munshi & Bruno L. Ferreyro

  3. Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France

    Guillaume Dumas

  4. Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada

    Bram Rochwerg

  5. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

    Bram Rochwerg

  6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Dean A. Fergusson

  7. Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Dean A. Fergusson

  8. Department of Medicine at Queen’s University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada

    Paul Heffernan

  9. Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada

    Margaret Herridge

  10. Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada

    Sheldon Magder

  11. Critical Care Department, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada

    Sheldon Magder

  12. Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada

    Mark Minden, Aaron Schimmer & Santhosh Thyagu

  13. Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Rakesh Patel

  14. Department of Critical Care Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Rakesh Patel

  15. Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada

    Salman Qureshi

  16. Division of Critical Care MedicineDepartment of Medicine at Hopital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada

    Han Ting Wang

Authors
  1. Laveena Munshi
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  2. Guillaume Dumas
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  3. Bram Rochwerg
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  4. Farah Shoukat
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  5. Michael Detsky
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  6. Dean A. Fergusson
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  7. Bruno L. Ferreyro
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  8. Paul Heffernan
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  9. Margaret Herridge
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  10. Sheldon Magder
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  11. Mark Minden
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  12. Rakesh Patel
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  13. Salman Qureshi
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  14. Aaron Schimmer
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  15. Santhosh Thyagu
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  16. Han Ting Wang
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  17. Sangeeta Mehta
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Corresponding author

Correspondence to Laveena Munshi.

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Munshi, L., Dumas, G., Rochwerg, B. et al. Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study. Intensive Care Med 50, 561–572 (2024). https://doi.org/10.1007/s00134-024-07349-z

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  • DOI: https://doi.org/10.1007/s00134-024-07349-z

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