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Outcome of critically ill patients with hematological malignancies

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Abstract

The prognosis for patients with hematological malignancies (HMs) admitted to the intensive care unit (ICU) is poor. The objective of this study was to evaluate the clinical characteristics and hospital outcomes of critically ill patients with HMs admitted to an oncological ICU. This is a prospective, observational cohort study. A total of 102 patients with HMs admitted to ICU from January 2008 to April 2011 were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. During the study period, 3,776 patients with HM were admitted to the Department of Hematology of the Instituto Nacional de Cancerología located in Mexico City, Mexico. After being evaluated by the intensivist, 102 (2.68 %) patients were admitted to the ICU. The ICU mortality rates for patients who had two or less organ system failures and for those with three or more organ system dysfunctions were 20 % (5/25) and 70.1 % (54/77), respectively (P < 0.0001). A multivariate analysis identified independent prognostic factors of inhospital death as neutropenia at the time of ICU admission (odds ratio (OR), 4.24; 95 % confidence interval (CI), 1.36–13.19, P = 0.012), the need for vasopressors (OR, 4.49; 95 % CI, 1.07–18.79, P = 0.040), need for invasive mechanical ventilation (OR, 4.49; 95 % CI, 1.07–18.79, P = 0.040), and serum creatinine >106 μmol/L (OR, 3.21; 95 % CI, 1.05–9.85, P = 0.041). The ICU and hospital mortality rates were 46.1 and 57.8 %, respectively. The independent prognostic factors of inhospital death were the need for invasive mechanical ventilation, the need for vasopressors, serum creatinine >106 μmol/L, and neutropenia at the time of ICU admission.

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Acknowledgments

We thank the nurses and medical staff of the intensive care unit at INCan, Mexico City, who were involved in the care of these patients for their assistance.

Conflict of interest

The authors declared that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Instituto Nacional de Cancerología, México. Av. San Fernando No. 22, Col. Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico

    Silvio A. Ñamendys-Silva, María O. González-Herrera, Francisco J. García-Guillén & Julia Texcocano-Becerra

  2. Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Silvio A. Ñamendys-Silva

  3. Division of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico

    Angel Herrera-Gómez

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  1. Silvio A. Ñamendys-Silva
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  2. María O. González-Herrera
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  3. Francisco J. García-Guillén
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  4. Julia Texcocano-Becerra
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  5. Angel Herrera-Gómez
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Correspondence to Silvio A. Ñamendys-Silva.

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Ñamendys-Silva, S.A., González-Herrera, M.O., García-Guillén, F.J. et al. Outcome of critically ill patients with hematological malignancies. Ann Hematol 92, 699–705 (2013). https://doi.org/10.1007/s00277-013-1675-7

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  • DOI: https://doi.org/10.1007/s00277-013-1675-7

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