Changes in severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU
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To determine whether severity and organ failure scores over the first 3 days in an ICU predict in-hospital mortality in onco-hematological malignancy patients.
Design and setting
Retrospective study in a 22-bed medical ICU.
92 consecutive patients with onco-hematological malignancies including 20 hematopoietic stem cell transplantation (HSCT) patients (11 with allogenic HSCT).
Simplified Acute Physiology Score (SAPS) II, Organ Dysfunction and/or Infection (ODIN) score, Logistic Organ Dysfunction System (LODS), and Sequential Organ Failure Assessment (SOFA) score were recorded on admission. The change in each score (Δ score) during the first 3 days in the ICU was calculated as follows: severity or organ failure score on day 3 minus severity or organ failure score on day 1, divided by severity or organ failure score on day 1.
In-hospital mortality was 58%. Using multivariate analysis in-hospital mortality was predicted by all scores on day 1 and all Δ scores. Areas under the receiver operating characteristics curves were similar for SAPS II (0.78), ODIN (0.78), LODS (0.83), and SOFA (0.78) scores at day 1. They were also similar for ΔSAPS II, ΔODIN, ΔLODS, and ΔSOFA. Similar results were observed when excluding patients with allogenic HSCT.
Severity and three organ failure scores on day 1 and Δ scores perform similarly in predicting in-hospital mortality in ICU onco-hematological malignancy patients but do not predict individual outcome. Decision to admit such patients to the ICU or to forgo life-sustaining therapies should not be based on these scores.
KeywordsSeverity scores Organ failure scores Onco-hematological malignancies Prognosis Intensive care
We thank Jean-Louis Teboul for his fruitful comments for reviewing the manuscript and Mary Kenny for her valuable advice for editing the manuscript. Part of this study was presented in abstract form at the American Thoracic Society International Conference at San Diego in May 2005 (American Journal of Respiratory and Critical Care Medicine, vol. 2, A430).
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