Outcome in critically ill medical patients requiring renal replacement therapy for acute renal failure: comparison between patients with and without hematologic malignancies
© BioMed Central Ltd. 2004
Published: 15 March 2004
Starting renal replacement therapy (RRT) for acute renal failure in critically ill patients with hematologic malignancies (HM) is controversial because of the poor outcome and high costs. The aim of this study was to compare the outcome of critically ill patients requiring RRT with and without HM as well as to assess whether the presence of HM is independently related to a higher mortality in this population.
We retrospectively collected data on all consecutive patients requiring RRT at the Ghent University Medical Intensive Care Unit (ICU) between 1997 and 2002, and analyzed the impact of the presence of HM on the mortality rate within 6 months after ICU admission by Cox proportional hazard models.
Fifty of the 222 (22.5%) consecutive patients with HM admitted to the ICU over the study period required RRT compared with 248 of the 4293 (5.8%) patients without HM (P < 0.001). Among patients requiring RRT, those with HM had higher crude ICU mortality rates (80% vs 55.7%, P = 0.001), inhospital mortality rates (84% vs 66.1%, P = 0.017) and 6-month mortality rates (86% vs 74.5%, P = 0.09) compared with those without HM. However, patients with HM were more severely ill (APACHE II, 30 ± 10 vs 26 ± 9, P = 0.017), more often required mechanical ventilation (88% vs 77.5%, P = 0.02) and had longer duration of hospitalization before admission (median [interquartile range] of 7 days [1–21] vs 0 days [0–2], P < 0.001) compared with those without HM. In a multivariate analysis only the APACHE II score (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.02–1.06, P < 0.001), vasopressor use (HR 1.97; 95% CI 1.28–3.02, P = 0.002) and a duration of hospitalization > 2 days before ICU admission (HR 1.5; 95% CI 1.1–2, P = 0.009) were associated with a poor outcome. The presence of HM was not associated with a poor outcome (HR 1.07; 95% CI 0.73–1.57, P = 0.78).
Withholding RRT to critically ill patients with HM is unjustified. The decision to start RRT in these patients should be based upon the severity of illness and the duration of hospitalization before admission to the ICU.