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Clinical Outcomes and Determinants of Survival in Patients with Hematologic Malignancies Admitted to Intensive Care Units with Critical Illness

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Abstract

Outcomes of patients with hematologic malignancies requiring ICU care for critical illness are suboptimal and represent a major unmet need in this population. We present data from a dedicated haematology oncology setting including 63 patients with a median age of 60 years admitted to the ICU for critical illness with organ dysfunction. The most common underlying diagnosis was multiple myeloma (30%) followed by acute myeloid leukemia (25%). Chemotherapy had been initiated for 90.7% patients before ICU admission. The most common indication for ICU care was respiratory failure (36.5%) and shock (17.5%) patients. Evidence of sepsis was present in 44 (69%) patients. After shifting to ICU, 32 (50%) patients required inotropic support and 18 (28%) required invasive mechanical ventilation. After a median of 5 days of ICU stay, 43.1% patients had died, most commonly due to multiorgan dysfunction. Risk of mortality was higher with involvement of more than two major organs (p = .001), underlying AML (p = .001), need for mechanical ventilation (p = .001) and high inotrope usage (p = .004). Neutropenia was not associated with mortality. Our study indicates high rates of short term mortality and defines prognostic factors which can be used to prognosticate patients and establish goals of care.

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References

  1. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent J-L (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13(1):R15

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for lifethreatening medical complications of haematological malignancy. Br Med J (Clin Res Ed) 296(6628):1025–1029

    Article  CAS  PubMed  Google Scholar 

  3. Manjappachar NK, Cuenca JA, Ramírez CM, Hernandez M, Martin P, Reyes MP et al (2022) Outcomes and predictors of 28-day mortality in patients with hematologic malignancies and septic shock defined by sepsis-3 criteria. J Natl Compr Canc Netw 20(1):45–53

    Article  PubMed  Google Scholar 

  4. Buchman TG, Simpson SQ, Sciarretta KL, Finne KP, Sowers N, Collier M et al (2020) Sepsis among medicare beneficiaries: 1. The burdens of sepsis, 2012-2018. Crit Care Med 48(3):276–88

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hawari FI, Nazer LH, Addassi A, Rimawi D, Jamal K (2016) Predictors of ICU admission in patients with cancer and the related characteristics and outcomes: a 5-year registry-based study. Crit Care Med 44(3):548–553

    Article  PubMed  Google Scholar 

  6. Kubihal V, Chandrashekhara SH, Triveni GS (2022) Clinical imaging in oncological ICU. In: Kumar V, Gupta N, Mishra S (eds) Onco-critical care: an evidence-based approach. Springer Nature Singapore, Singapore, pp 37–50

    Chapter  Google Scholar 

  7. Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL et al (2004) Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care (London, England) 8(5):R291–R298

    Article  Google Scholar 

  8. Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S et al (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16(5):291–297

    Article  CAS  PubMed  Google Scholar 

  9. Evison J, Ritz R, Elsasser S (2001) Intensive care unit admission in patients with hematological disease: incidence, outcome and prognostic factors. Swiss Med Wkly 131(4748):681–686

    CAS  PubMed  Google Scholar 

  10. Owczuk R, Wujtewicz MA, Sawicka W, Wadrzyk A, Wujtewicz M (2005) Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 13(5):332–338

    Article  Google Scholar 

  11. Gordon AC, Oakervee HE, Kaya B, Thomas JM, Barnett MJ, Rohatiner AZ et al (2005) Incidence and outcome of critical illness amongst hospitalised patients with haematological malignancy: a prospective observational study of ward and intensive care unit based care. Anaesthesia 60(4):340–347

    Article  CAS  PubMed  Google Scholar 

  12. Senapati J, Dhawan R, Aggarwal M, Kumar P, Kumar Vishwanathan G, Dass J et al (2021) Venetoclax and azacitidine (VenAZA) combination therapy in young unfit patients with AML: a perspective from a developing country. Leuk Lymphoma 62(6):1514–1517

    Article  CAS  PubMed  Google Scholar 

  13. Jobanputra KN, Nayak L, Jain H, Sengar DM (2021) Diffuse large B-cell lymphoma in the elderly: retrospective analysis from a single tertiary cancer center in India. Blood 138:2515

    Article  Google Scholar 

  14. Shaikh MRMA, Mehta P, Mirgh SP, Halder R, Agrawal N, Khushoo V et al (2021) Individualized AML induction with venetoclax based therapy in unfit treatment naïve patients aged ≤ 60 years: a real world perspective from India. Blood 138:4417

    Article  Google Scholar 

  15. Hammond NE, Kumar A, Kaur P, Tirupakuzhi Vijayaraghavan BK, Ghosh A, Grattan S et al (2022) Estimates of sepsis prevalence and outcomes in adult patients in the ICU in India: a cross-sectional study. Chest 161(6):1543–1554

    Article  PubMed  Google Scholar 

  16. Chaudhry D, Prajapat B (2017) Intensive care unit bugs in India: How do they differ from the western world? J Assoc Chest Phys 5(1):10–17

    Google Scholar 

  17. Philip C, George B, Ganapule A, Korula A, Jain P, Alex AA et al (2015) Acute myeloid leukaemia: challenges and real world data from India. Br J Haematol 170(1):110–117

    Article  PubMed  PubMed Central  Google Scholar 

  18. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA (2019) Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int 96(5):1083–1099

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH et al (2021) KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 99(3):S1–S87

    Article  Google Scholar 

  21. Franco L, Becattini C, Beyer-Westendorf J, Vanni S, Nitti C, Re R et al (2020) Definition of major bleeding: prognostic classification. J Thromb Haemost 18(11):2852–2860

    Article  CAS  PubMed  Google Scholar 

  22. Zimmer AJ, Freifeld AG (2019) Optimal management of neutropenic fever in patients with cancer. J Oncol Pract 15(1):19–24

    Article  PubMed  Google Scholar 

  23. Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE et al (2019) Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis 71(6):1367–1376

    Article  PubMed Central  Google Scholar 

  24. Belletti A, Lerose CC, Zangrillo A, Landoni G (2021) Vasoactive-inotropic score: evolution, clinical utility, and pitfalls. J Cardiothorac Vasc Anesth 35(10):3067–3077

    Article  CAS  PubMed  Google Scholar 

  25. Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R et al (2021) Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 47(10):1104–1114

    Article  PubMed  Google Scholar 

  26. de Vries VA, Müller MCA, Arbous MS, Biemond BJ, Blijlevens NMA, Kusadasi N et al (2019) Long-term outcome of patients with a hematologic malignancy and multiple organ failure admitted at the intensive care. Crit Care Med 47(2):e120–e128

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tridente A, Dempsey NC, Khalifa M, Goddard J, Shuker K, Hall J et al (2023) Predicting outcomes of hematological malignancy patients admitted to critical care. Front Hematol 2. https://doi.org/10.3389/frhem.2023.1127322

  28. Siddiqui SS, Prabu NR, Chaudhari HK, Narkhede AM, Sarode SV, Dhundi U et al (2021) Epidemiology, clinical characteristics, and prognostic factors in critically ill patients with hematolymphoid malignancy. Indian J Crit Care Med: Peer-reviewed, Off Publ Indian Soc Crit Care Med 25(1):56–61

    Article  Google Scholar 

  29. Moreno-Sanchez F, Gomez-Gomez B (2022) Antibiotic management of patients with hematologic malignancies: from prophylaxis to unusual infections. Curr Oncol Rep 24(7):835–842

    Article  PubMed  PubMed Central  Google Scholar 

  30. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR et al (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25(12):1395–1401

    Article  CAS  PubMed  Google Scholar 

  31. Hampshire PA, Welch CA, McCrossan LA, Francis K, Harrison DA (2009) Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC case mix programme database. Crit Care (London, England) 13(4):R137

    Article  Google Scholar 

  32. van Mourik N, Oomen JJ, van Vught LA, Biemond BJ, van den Bergh WM, Blijlevens NM et al (2023) The predictive value of the modified early warning score for admission to the intensive care unit in patients with a hematologic malignancy–a multicenter observational study. Intensive Crit Care Nurs 79:103486

    Article  PubMed  Google Scholar 

  33. Yoo J-W, Lee JR, Jung YK, Choi SH, Son JS, Kang BJ et al (2015) A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock. Korean J Intern Med 30(4):471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lee JR, Jung YK, Kim HJ, Koh Y, Lim CM, Hong SB et al (2020) Derivation and validation of modified early warning score plus SpO2/FiO2 score for predicting acute deterioration of patients with hematological malignancies. Korean J Intern Med 35(6):1477–1488

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mato A, Fuchs BD, Heitjan DF, Mick R, Halpern SD, Shah PD et al (2009) Utility of the systemic inflammatory response syndrome (SIRS) criteria in predicting the onset of septic shock in hospitalized patients with hematologic malignancies. Cancer Biol Ther 8(12):1095–1100

    Article  PubMed  Google Scholar 

  36. Mato AR, Luger SM, Heitjan DF, Mikkelson ME, Olson E, Ujjani C et al (2010) Elevation in serum lactate at the time of Febrile Neutropenia (FN) in hemodynamically-stable patients with Hematologic Malignancies (HM) is associated with the development of septic shock within 48 hours. Cancer Biol Ther 9(8):585–589

    Article  CAS  PubMed  Google Scholar 

  37. Nathan N, Sculier JP, Ameye L, Paesmans M, Bogdan-Dragos G, Meert AP (2021) Sepsis and septic shock definitions in patients with cancer admitted in ICU. J Intensive Care Med 36(3):255–261

    Article  PubMed  Google Scholar 

  38. Yeo CD, Kim JW, Kim SC, Kim YK, Kim KH, Kim HJ et al (2012) Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit Care 27(6):739.e1-739.e6

    Article  PubMed  Google Scholar 

  39. Cetintepe T, Cetintepe L, Solmaz S, Calık S, Ugur MC, Gediz F et al (2021) Determination of the relationship between mortality and SOFA, qSOFA, MASCC scores in febrile neutropenic patients monitored in the intensive care unit. Support Care Cancer 29(7):4089–4094

    Article  PubMed  PubMed Central  Google Scholar 

  40. Al-Zubaidi N, Shehada E, Alshabani K, ZazaDitYafawi J, Kingah P, Soubani AO (2018) Predictors of outcome in patients with hematologic malignancies admitted to the intensive care unit. Hematol Oncol Stem Cell Ther 11(4):206–218

    Article  PubMed  Google Scholar 

  41. Wang T, Zhang L, Luo K, He J, Ma Y, Li Z et al (2016) Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. BMC Pulm Med 16(1):129

    Article  PubMed  PubMed Central  Google Scholar 

  42. Liu J, Bell C, Campbell V, DeBacker J, Tamberg E, Lee C et al (2019) Noninvasive ventilation in patients with hematologic malignancy: a retrospective study. J Intensive Care Med 34(3):197–203

    Article  Google Scholar 

  43. Amado-Rodríguez L, Bernal T, López-Alonso I, Blázquez-Prieto J, García-Prieto E, Albaiceta GM (2016) Impact of initial ventilatory strategy in hematological patients with acute respiratory failure: a systematic review and meta-analysis. Crit Care Med 44(7):1406–1413

    Article  PubMed  Google Scholar 

  44. Wise MP, Barnes RA, Baudouin SV, Howell D, Lyttelton M, Marks DI et al (2015) Guidelines on the management and admission to intensive care of critically ill adult patients with haematological malignancy in the UK. Br J Haematol 171(2):179–188

    Article  PubMed  Google Scholar 

  45. Huaringa AJ, Francis WH (2019) Outcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer. J Crit Care 50:87–91

    Article  PubMed  Google Scholar 

  46. Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur A (2009) Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 31(9):623

    Article  PubMed  PubMed Central  Google Scholar 

  47. Choudhari S, Gawande R, Watchmaker J, Bamnote P, Mishra P, Dwivedi P (2023) Bloodstream infections in cancer patients in central India: trend over five years. Access Microbiol 000673. https://doi.org/10.1099/acmi.0.000673.v1

  48. Kumar K, Subash C, Prabhu D, Pulikkal D, Basker D (2021) Pattern of bacterial infections in Indian bone marrow transplant patients-experience from Chennai India. Blood 138:4855

    Article  Google Scholar 

  49. Chauhan P, Gupta A, Gopinathan M, Sanjeev GA, Khanna S et al (2022) Real-world challenges in the management of acute myeloid leukemia: a single-center experience from North India. Ann Hematol 101(6):1261–73

    Article  CAS  PubMed  Google Scholar 

  50. Ghosh S, Chakraborty M, Samanta S, Sinha N, Saha S, Chattopadhyay A et al (2021) Analysis of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India. Ann Hematol 100(2):395–403

    Article  CAS  PubMed  Google Scholar 

  51. Peter JV, Thomas K, Jeyaseelan L, Yadav B, Sudarsan TI, Christina J et al (2016) Cost of intensive care in India. Int J Technol Assess Health Care 32(4):241–245

    Article  PubMed  Google Scholar 

  52. Singh S, Lionel S, Jain H, Nayak L, Selvarajan S, Samuel P et al (2022) Real world data on unique challenges and outcomes of older patients with AML from resource limited settings: Indian acute leukemia research database (INwARD) of the hematology cancer consortium (HCC). Blood 140(Supplement 1):6096–6098

    Article  Google Scholar 

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Acknowledgements

SS and VG designed the research study and protocols. SS, RS and GK performed the research and data entry. SS, JS and KJ performed literature search and statistical analysis. SS and PG analyzed and verified the data. SS, JS and PG wrote the paper and reviewed the final version. The authors thank Ms Namita Bansal for performing statistical analysis for this study.

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Authors and Affiliations

  1. Department of Clinical Hematology and Stem Cell Transplantation, Bone Marrow Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India

    Suvir Singh & Rintu Sharma

  2. Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, India

    Jagdeep Singh & Kunal Jain

  3. Department of Cardiac Anaesthesia, Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, India

    Gurkirat Kaur & Vivek Gupta

  4. Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, India

    P. L. Gautam

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  1. Suvir Singh
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Singh, S., Sharma, R., Singh, J. et al. Clinical Outcomes and Determinants of Survival in Patients with Hematologic Malignancies Admitted to Intensive Care Units with Critical Illness. Indian J Hematol Blood Transfus (2024). https://doi.org/10.1007/s12288-024-01757-3

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