Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies

Abstract

Objective. To assess the outcome of intensive care unit (ICU) treatment in patients with hematological malignancies.

Design and setting. Retrospective cohort study in the medical ICU of a university hospital.

Patients. 104 critically ill patients after receiving conventional chemotherapy or autologous hematopoietic stem cell transplantation.

Interventions. We analyzed demographic data, underlying disease, intensity of antineoplastic regimen, cause of admission, need for mechanical ventilation, and hemofiltration, ICU survival, and survival after discharge, furthermore neutrophil count, C-reactive protein (≤150 vs. >150 mg/l), antithrombin III, prothrombin time, and SAPS II (≤50 vs. >50) at ICU admission. All recorded variables were evaluated for prognostic relevance by univariate and multivariate analyses.

Measurements and results. Overall ICU mortality was 44%, with significantly higher mortality in ventilated patients (74% vs. 12% in nonventilated patients, p<0.001). Overall survival for the entire group 6 months and 1 year after ICU admission was 33% and 29%, respectively. Multivariate analysis revealed mechanical ventilation and SAPS II as independent prognostic factors of both ICU mortality and long-term survival, while C-reactive protein predicted only ICU mortality.

Conclusions. The outcome of patients not requiring ventilatory support in this study was encouraging, while invasive ventilation was again confirmed as predicting a dismal prognosis in this population. Efforts should be directed to avoiding this procedure by reducing the pulmonary toxicity of antineoplastic treatment and to making ventilatory support more tolerable.