Retrospective study of patients with haematological malignancies admitted in an intensive care unit

Introduction

The development of aggressive schemes of chemotherapy predisposes haematological patients to various life-threatening complications. The admission of neutropenic patients into an intensive care unit (ICU) is still controversial mainly if they have multiple organ dysfunction (MOD) and /or if mechanical ventilation is required.

Objective

Analyses from patients with haematological malignancies admitted in a medico-surgery ICU of an oncology hospital.

Patients and methods

Retrospective observational study on patients with haematological malignancies admitted in ICU from October/96 to October/98, coming from Paediatric Department (PD), Onco-Haematological Unit (OHU) and Bone Marrow Transplantation Unit (BMTU). We analysed the patient data, namely the underlying malignancy, the reason for admission, the type and number of organ dysfunction (including neutropenia and requirement of mechanical ventilation), the time in ICU, acute physiology, age, chronic health evaluation (APACHE II) and sepsis-related organ failure assessment (SOFA).

Results

Between October/96 and October/98, 46 onco-haematological patients were admitted in the UCI (56 inpatients) with ages from 9 months to 70 years old, 23 female/23 male: 6 came from PD (13%), 29 from OHU (63%) and 11 from BMTU (24%).

Underlying haematological malignancy: Non Hodgkin Lymphoma (34%), Acute Myeloid Leukaemia (21%), Chronic Myeloid Leukaemia (15%), Hodgkin Disease (15%), Acute Lymphoid leukaemia (11%), Multiple myeloma (4%). Six of the 46 patients were excluded because of the short time in ICU (≤ 12 h). Six patients were readmitted. The mean time of stay was 8.2 days. The reasons for ICU admission were: acute respiratory failure (54%), multi-organ dysfunction (MOD; 14%), post-surgery (14%), septic shock (8%), tumour lysis syndrome (6%), hypovolemic shock (2%) and neurological dysfunction (2%). The ICU mortality was 52.5%, being 76% of them neutropenic patients with MOD and requiring invasive ventilation. 89% of the patients coming from BMTU died.

Conclusion

The main risk factors to dead in an ICU are the number of organ dysfunction at admission, the requirement of invasive ventilation, BMT, APACHE II ≥ 20 and SOFA ≥ 15.