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

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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.

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Conflict of interest statement

None of the authors have financial or other potential conflicts of interest.

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Authors and Affiliations

  1. Department of Public Health and Health Economics, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Dominique M. Vandijck

  2. Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Dominique M. Vandijck & Renaat A. Peleman

  3. Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Pieter O. Depuydt, Joke Nollet, Johan M. Decruyenaere & Dominique D. Benoit

  4. Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Fritz C. Offner, Eva Steel & Lucien A. Noens

Authors
  1. Dominique M. Vandijck
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  2. Pieter O. Depuydt
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  3. Fritz C. Offner
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  4. Joke Nollet
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  5. Renaat A. Peleman
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  6. Eva Steel
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  7. Lucien A. Noens
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  8. Johan M. Decruyenaere
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  9. Dominique D. Benoit
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Correspondence to Dominique M. Vandijck.

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Vandijck, D.M., Depuydt, P.O., Offner, F.C. et al. Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. Intensive Care Med 36, 1744–1750 (2010). https://doi.org/10.1007/s00134-010-1903-8

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  • DOI: https://doi.org/10.1007/s00134-010-1903-8

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