Is intensive care beneficial for patients with haematologic malignancies?

Introduction

Despite a better prognosis for patients with haematologic malignancies (PHM) over these past years due to progress in management, intensivists are reluctant to admit those patients to the ICU because of high mortality rates, above 50%. The aim of this study was to retrospectively evaluate the value of intensive care therapy of PHM and predictive factors of short-term and long-term survival with the best post-ICU quality of life.

Methods

The case notes of 88 PHM patients requiring admission to a 25-bed medical-surgical ICU of Roubaix Hospital, France were retrospectively reviewed during a 5-year period, 2003 to 2007. We collected demographic factors, Simplified Acute Physiology Score II (SAPS II), Logistic Organ Dysfunction System score (LODS), Charlson score, microbiology, status of underlying HM, haematologic factor data, therapeutic support, blood cell transfusion, and survival follow-up (at the first 48 hours on the ICU, at discharge from the ICU, at 3, 12 and 18 months after ICU).

Results

Univariate logistic regression analysis of factors previously shown to influence survival revealed that HM status, Charlson score, PaO₂/FiO₂ <200, during mechanical ventilation, blood cell transfusion, and outcome in the first 48 hours on the ICU were significantly associated with survival (P < 0.05). PHM with a favourable course (treatment response) in the first 48 hours on the ICU had a better survival rate (95.7%) than an unfavourable course (33.3%) (P < 0.001). There was a correlation between mean SAPS II, LODS and outcome at the first 48 hours on the ICU (P = 0.03). Using multivariate analysis identified three variables independently associated with ICU survival: two negative, mechanical ventilation (HR = 4.9) and LODS score (HR = 1.12); one protective factor, red blood cell transfusion (HR = 0.7) without additional cost. ICU, 3-month, 12-month and 18-month survivals were respectively 69.3% (61/88), 37.5% (33/88), 27.3% (24/88) and 23.8% (21/88) with a mean performance status at 1.03 ± 1, a mean Karnofsky index at 77.6 ± 15.

Conclusions

The ICU management provided benefit for PHM cases referred earlier to the ICU because of the good quality of life for long-term survivors. Therefore, the unlimited life-sustaining treatment should be re-evaluated on the first 48 hours in the ICU based on SAPS II, LODS and Charlson scores.