Outcomes and Prognostic Factors in Patients with Hematologic Malignancies in the Intensive Care unit: A Single-Center Cohort Study of 233 Cases in Taiwan
BackgroundPatients with a hematologic malignancies (HM) have one of the highest mortality rates among cancer patients admitted to the medical intensive care unit (ICU). The aim of this study was to identify outcomes and risk factors that predict the prognosis of critically ill patients with HM in the ICU.MethodsA retrospective observational study was conducted in a tertiary referral hospital in Taiwan over 40 months (January 1, 2017–April 30, 2020). All adult patients with HM who were admitted
... o medical ICU were enrolled. Clinical data upon hospital and ICU admission were collected. The predictors of ICU mortality were evaluated using a multivariate analysis.ResultsA total of 233 patients with HM met the inclusion criteria. The median age (SD) was 59.3 (15.1) years, and 76% of the HMs were classified as high-grade disease. The median (IQR) Sequential Organ Failure Assessment (SOFA) score at ICU admission was 11 (9–15); Simplified Acute Physiology Score II, 64 (51–80); and Acute Physiology and Chronic Health Evaluation II score, 28 (23–34). The most common reasons for ICU admission were acute respiratory failure (63.1%) and septic shock (19.7%). The ICU and hospital mortality rates were 54.1% and 67.8%, respectively. A multivariate analysis revealed that the initiation of renal replacement therapy in the ICU (odds ratio [OR], 3.88; 95% CI, 1.66–9.08) and SOFA score (OR, 1.16; 95% CI, 1.03–1.31) were independently associated with ICU mortality.ConclusionsThe ICU and hospital outcomes of critically ill patients with HM are improving. Performance status, cancer status, invasive mechanical ventilation, severe neutropenia, and transplantation status were not identified as predictive factors of ICU outcome. Initiation of renal replacement therapy in the ICU and the SOFA score upon ICU admission were independently associated with ICU mortality. We suggest early and timely ICU admission of patients at risk of multiorgan failure.