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Evaluation of patients with acute leukemia admitted to an intensive care unit

Introduction

Patients with acute leukemia often confront themselves with critical illness during the course of their disease. Intensive care unit (ICU) admission of such patients carries a significant mortality. The mortality rate of critically ill patients with acute leukemia may be higher than 80%.

Objective

To evaluate prospectively the characteristics of acute leukemia patients admitted to an ICU.

Materials and methods

During the period from January 1998 to December 2002 we evaluated patients with the diagnosis of acute leukemia admitted to a medical-surgical ICU of a 560-bed tertiary hospital in southern Brazil. The variables evaluated were: age, Acute Physiology and Chronic Health Evaluation II score classification, time of mechanical ventilation, time from ICU admission to shock, admission time before admission to the ICU, length of stay in the ICU and total hospital length of stay, incidence of septic shock, use of invasive hemodynamic monitoring through a Swan–Ganz catheter, and ICU and hospital survival. Statistical analysis was performed with the SPSS 11.0 software package using a t test and Kruskall-Wallis statistics where appropriate, with a significance level set at 5%.

Results

In the period from January 1998 to December 2002 there were 44 patients admitted with a diagnosis of acute leukemia. The findings obtained from these patients were compared with those of 1753 patients without the diagnosis of acute leukemia admitted to the ICU in the same period. In the acute leukemia group, the mean age was 48 ± 18 years, the mean Acute Physiology and Chronic Health Evaluation II score at admission was 22.7 ± 6.4, and the incidence of septic shock was 34.1%, with an overall ICU survival of 18%. Summarized data are presented in Table 1.

Table 1 :

Conclusions

Patients with acute leukemia admitted to an ICU present an elevated risk of death, despite the progress in the care of critically ill patients achieved in recent years. The ICU admission of acute leukemia patients remains a controversial issue, based on conflicting data in the literature [1, 2]. Because there is no survival prediction tool accurate enough to evaluate these patients, their admission to an ICU must be dependent on an individualized assessment of the current critical illness.

References

  1. 1.

    Peters SG, Meadows JA 3rd, Gracey DR: Outcome of respiratory failure in hematologic malignancy. Chest 1988, 94: 99-102.

  2. 2.

    Massion P, Dive A, Doyen C, Jamart J, Bosly A, Installé E: Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 2002, 30: 2260-2270. 10.1097/00003246-200210000-00014

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Nagel, F., Canabarro, M., Wawrzeniak, I. et al. Evaluation of patients with acute leukemia admitted to an intensive care unit. Crit Care 7, P88 (2003). https://doi.org/10.1186/cc2284

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Keywords

  • Intensive Care Unit
  • Septic Shock
  • Intensive Care Unit Admission
  • Critical Illness
  • Acute Leukemia