Prognosis of patients with haematological malignancies admitted to the ICU

Introduction

When admission to the ICU is deemed necessary in patients with haematological malignancy, prognosis is extremely poor, with reported ICU mortality rates of 38–73% and even higher inhospital and long-term mortality. In the presence of conditions associated with 100% mortality, cessation of or negation to initiate therapy would be justified. The aim of this study was to evaluate the outcome, and to identify clinically useful prognostic parameters in this group of patients.

Methods

The study retrospectively included 86 patients with haematological malignancy, admitted to the ICU of the University Hospital Maastricht between December 1999 and December 2005. Demographic data, characteristics of haematological disease, therapy and complications, indication for ICU admission, clinical parameters, laboratory values, interventions on the ICU, APACHE II and SOFA scores, as well as ICU and hospital mortality were collected.

Results

ICU mortality was 56% and inhospital mortality was 65%. Nonsurvivors had higher APACHE II and SOFA scores than survivors (32 ± 8.0 vs 25 ± 6.5 and 11.5 ± 3.1 vs 8.5 ± 3.0, respectively). Mortality was higher in patients with invasive mechanical ventilation, in patients with inotropic/vasopressor therapy and in cardiopulmonary resuscitated patients. Patients with an increasing SOFA score over the first week (≥ 2 points) had significantly higher mortality rates, and patients with a decrease (≥ 2 points) had significantly lower mortality rates (P = 0.005). Subgroups with 100% mortality included patients with myeloablative allogeneic stem cell transplantation in the past year (n = 9), reactivation of cytomegalovirus (n = 6) and acute lymphoblastic leukaemia (n = 5). Presence of neutropenia was not associated with higher mortality, neither were disease status, indication for ICU admission, graft-versus-host disease, chronic use of immunosuppressive medication, left ventricular ejection fraction ≤ 40% or bacteraemia.

Conclusion

The mortality of patients with haematological malignancies admitted to the ICU is high and mainly associated with severity of illness, reflected in organ failure scores, need for mechanical ventilation and inotropic or vasopressor therapy. Although several factors are associated with poor outcome, no absolute predictors of mortality were identified.