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Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit?

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Abstract

Introduction

Patients with hematological malignancies (HM) require intensive chemotherapy with curative intent, especially in case of AML that results in more frequent admissions to Intensive Care Units (ICU). Due to our knowledge, this study is the first multicenter retrospective analysis in Polish population.

Methods

A total of 200 patients with HM hospitalized in 4 Polish hematological centers. Data concerning clinical indices and outcomes during admission and ICU stay were collected retrospectively.

Results

The most common hematological malignancy was acute leukemia (55%). The main cause of ICU admission was respiratory failure (88.5%), often accompanied by sepsis (58.5%) and acute renal failure (51.5%). In patients with hematological malignancies, the following factors were associated with ICU mortality: prolonged ICU stay (odd ratio [OR] = 6.98, 95% confidence interval [CI]: 1.38-35.33, χ2 = 5.61, p = 0.02), the presence of acute respiratory failure (odd ratio [OR] = 5.35, 95% confidence interval [CI]: 1.01–28.46, χ2 = 3.93, p = 0.04), and the need for renal replacement therapy (odd ratio [OR] = 8.75, 95% confidence interval [CI]: 1.23–62.11, χ2 = 4.78, p = 0.03). There were following associations with in-hospital mortality in patients with hematological malignancies: prolonged ICU stay (odd ratio [OR] = 10.12, 95% confidence interval [CI]: 1.85–55.37, χ2 = 7.21, p = 0.008), the presence of acute respiratory failure (odd ratio [OR] =5.24, 95% confidence interval [CI]: 1.36–20.16, χ2 = 5.87, p = 0.02), the need for catecholamine support (odd ratio [OR] =3.43, 95% confidence interval [CI]: 1.06–11.05, χ2 = 4.32, p = 0.04), and renal replacement therapy (odd ratio [OR] =5.55, 95% confidence interval [CI]: 1.14–26.92, χ2 = 4.59, p = 0.03).

Conclusions

We have demonstrated that ICU and in-hospital mortalities among patients with hematological malignancies are still poor, but easier access to the intensive care unit and close cooperation between hematologists and intensivists may improve outcomes. We have found that acute failure of key organs (acute respiratory failure, end-stage renal failure requires renal replacement therapy) and length of ICU stay (but probably no comorbidities and illness severity) may have impact on mortality (both ICU and in-hospital).

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References

  1. Soubani AO, Decruyenaere J (2014) Improved outcome of critically ill patients with hematological malignancies: what’s next? Intensive Care Med 40(9):1377–1380

    Article  Google Scholar 

  2. Faucher E, Cour M, Jahandiez V et al (2016) Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis. Oncotarget. 7(16):22427–22438

    Article  Google Scholar 

  3. J Ferlay, HR Shin, F Bray, D Forman, C Mathers, DM Parkin GLOBOCAN 2008, Cancer incidence and mortality worldwide: IARC Cancer Base No. 10, International Agency for Research on Cancer, Lyon (2010)

  4. Azoulay E, Mokart D, Lambert J et al (2010) Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 182:1038–1046

    Article  Google Scholar 

  5. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 315(8):801–810

    Article  CAS  Google Scholar 

  6. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106:2912–2919

    Article  CAS  Google Scholar 

  7. Geerse DA, Span LF, Pinto-Sietsma SJ, van Mook WN (2011 Feb) Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality. Eur J Intern Med 22(1):57–61

    Article  Google Scholar 

  8. 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. Hematology/Oncology and Stem Cell Therapy 11(4):206–218

    Article  Google Scholar 

  9. Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC (2012) Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth 108(3):452–459

    Article  CAS  Google Scholar 

  10. de Vries VA, Müller MCA, Arbous MS, Biemond BJ, Blijlevens NMA, Kusadasi N, Span LRF, Vlaar APJ, van Westerloo D, Kluin-Nelemans HC, van den Bergh W, HEMA-ICU Study Group (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  Google Scholar 

  11. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G et al (2010) Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med, 38 (1)

  12. Azevedo L, Caruso P, Silva U, Torelly A, Silva E, Rezende E, Netto JJ, Piras C, Lobo SMA, Knibel MF, Teles JM, Lima RA, Ferreira BS, Friedman G, Rea-Neto A, Dal-Pizzol F, Bozza FA, Salluh JIF, Soares M, Brazilian Research in Intensive Care Network (BRICNet) (2014) Outcomes for patients with cancer admitted to the ICU requiring ventilatory support results from a prospective multicenter study. CHEST 146(2):257–266

    Article  Google Scholar 

  13. McGrath S, Chatterjee F, Whiteley C, Ostermann M (2010) ICU and 6-month outcome of oncology patients in the intensive care unit. Q J Med 103:397–403

    Article  CAS  Google Scholar 

  14. Hill QA, Kelly RJ, Patalappa C, Whittle AM, Scally AJ, Hughes A, Ashcroft AJ, Hill A (2012) Survival of patients with hematological malignancy admitted to the intensive care unit: prognostic factors and outcome compared to unselected medical intensive care unit admissions a parallel group study. Leukemia & Lymphoma 53(2):282–288

    Article  Google Scholar 

  15. Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, Ehninger G, Schuler U (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 28(9):1294–1300

    Article  Google Scholar 

  16. Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA et al (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99

    Article  Google Scholar 

  17. Staudinger T, Stoiser B, Mullner M, Locker G, Lackiza K, Knapp S et al (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28(5)

  18. Maqsood S, Badar F, Hameed A (2017) Characteristics and outcomes of patients with hematological malignancies admitted for intensive care - a single centre experience. Asian Pac J Cancer Prev 18(7):1833–1837

    PubMed  PubMed Central  Google Scholar 

  19. Azoulay E, Mokart D, Pene F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31:2810–2818

    Article  Google Scholar 

  20. Evison J, Rickenbacher P, Ritz R et al (2002) Intensive care unit admission in patients with haematological disease: incidence, outcome and prognostic factors. Swiss Med Wkly 131:681–686

    Google Scholar 

  21. Lamia B, Hellot M, Girault C et al (2006) Changes in severity and organ failure scores as prognostic factors in oncohematological malignancy patients admitted to the ICU. Intensive Care Med 32:1560–1568

    Article  CAS  Google Scholar 

  22. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112

    Article  Google Scholar 

  23. Cuthbertson BH, Rajalingham Y, Harrison S, McKirdy F (2008) The outcome of haematological malignancy in Scottish intensive care units. J Intensive Care Soc 9:135–140

    Article  Google Scholar 

  24. Liu J, Cheng Q, Yang Q, Li X, Shen X, Zhang L, Liu Z, Khoshnood K (2015) Prognosis-related factors in intensive care unit (ICU) patients with hematological malignancies: a retrospective cohort analysis in a Chinese population. Hematology 20(9):494–503

    Article  Google Scholar 

  25. Al-Dorzi Hasan M, Al Orainni H, Al Eid F, Tlayjeh H, Itani A, Al Hejazi A, Arabi YM (2017) Characteristics and predictors of mortality of patients with hematologic malignancies requiring invasive mechanical ventilation. Annals of Thoracic Medicine 12(4):259–265

    Article  CAS  Google Scholar 

  26. Soubani AO, Shehada E, Chen W, Smith D (2014) The outcome of cancer patients with acute respiratory distress syndrome. J Crit Care 29:183.e7–183.e12

    Article  Google Scholar 

  27. Azoulay É, Canet E, Raffoux E, Lengliné E, Lemiale V, Vincent F et al (2012) Dexamethasone in patients with acute lung injury from acute monocytic leukaemia. Eur Respir J 39:648–653

    Article  CAS  Google Scholar 

  28. Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Jourdain M, Renault A, Schlemmer B, Azoulay E (2016) Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. Ann Intensive Care 6(1):102

    Article  Google Scholar 

  29. Burghi G, Lemiale V, Seguin A, Lambert J, Lacroix C, Canet E, Moreau AS, Ribaud P, Schnell D, Mariotte E, Schlemmer B, Azoulay E (2011) Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis. Intensive Care Med 37:1605–1612

    Article  Google Scholar 

  30. Mokart D, Lambert J, Schnell D, Fouché L, Rabbat A, Kouatchet A et al (2013) Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma 39:250–254

    Google Scholar 

  31. Campbell G (2014) Adam et al. Acute kidney injury in the cancer patient. Adv Chronic Kidney Dis 21(1):64–71

    Article  Google Scholar 

  32. Munker R, Hill U, Jehn U, Kolb HJ, Schalhorn A (1998) Renal complications in acute leukemias. Haematologica. 83:416–421

    CAS  PubMed  Google Scholar 

  33. Christiansen CF, Johansen MB, Langeberg WJ, Fryzek JP, Sorensen HT (2011) Incidence of acute kidney injury in cancer patients: a Danish population-based cohort study. Eur J Intern Med. 22(4):399–406.2

    Article  Google Scholar 

  34. Canet E, Zafrani L, Lambert J, Thieblemont C, Galicier L, Schnell D, Raffoux E, Lengline E, Chevret S, Darmon M, Azoulay E (2013) Acute kidney injury in patients with newly diagnosed high-grade hematological malignancies: impact on remission and survival. PLoS One 8(2):e55870

    Article  CAS  Google Scholar 

  35. Aapro M, Launay-Vacher V (2012) Importance of monitoring renal function in patients with cancer. Cancer Treat Rev 38(3):235–240

    Article  Google Scholar 

  36. Launay-Vacher V, Spano JP, Janus N, Gligorov J, Ray-Coquard I, Oudard S, Pourrat X, Morere JF, Beuzeboc P, Deray G (2009) Renal insufficiency and anticancer drugs in elderly cancer patients: a subgroup analysis of the IRMA study. Crit Rev Oncology Hematol 70(2):124–133

    Article  Google Scholar 

  37. Schwilk B, Wiedeck H, Stein B, Reinelt H, Treiber H, Bothner U (1997) Epidemiology of acute renal failure and outcome of haemodiafiltration in intensive care. Intensive Care Med 23(12):1204–1211

    Article  CAS  Google Scholar 

  38. 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 13:332–338

    Article  Google Scholar 

  39. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35:808–814

    Article  Google Scholar 

  40. Lengline E, Raffoux E, Lemiale V et al (2012) Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure. Leuk Lymphoma 53:1352–1359

    Article  Google Scholar 

  41. De Montmollin E, Tandjaoui-Lambiotte Y, Legrand M et al (2013) Outcomes in critically ill cancer patients with septic shock of pulmonary origin. Shock. 39:250–254

    Article  Google Scholar 

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Authors and Affiliations

  1. Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland

    Elżbieta Kalicińska, Bartłomiej Kuszczak, Jakub Dębski, Justyna Rybka & Tomasz Wróbel

  2. Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland

    Łukasz Szukalski & Jarosław Czyż

  3. Department of Hematology, Institute of Hematology and Transfusion Medicine in Warsaw, Warsaw, Poland

    Marzena Wątek & Ewa Lech-Marańda

  4. Department of Hematology, Medical University of Gdańsk, Gdańsk, Poland

    Judyta Strzała & Jan Zaucha

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  1. Elżbieta Kalicińska
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Kalicińska, E., Kuszczak, B., Dębski, J. et al. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit?. Support Care Cancer 29, 323–330 (2021). https://doi.org/10.1007/s00520-020-05480-3

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