Abstract

Objective:

With new treatment modalities, the overall survival of patients with hematological malignancies (HM) has increased over the years. However, intensive care unit (ICU) mortality is still high. This study aimed to evaluate the clinical characteristics, treatment methods, and results of HM patients admitted to the ICU at a center in Turkey.

Materials and Methods:

Patients with HM admitted to the ICU between January 2013 and 2020 were retrospectively evaluated. A total of 172 adult patients with HM were included in the study.

Results:

The median (interquartile range) age of patients was 60 (47-67) years, admission Acute Physiology Assessment and Chronic Health Evaluation-II score was 30 (26-32), Sequential Organ Failure Assessment score was 10 (7-12). Results of the 172 patients, 60 (34.9%) had newly diagnosed malignancies, 16 (9.3%) were in remission, and 96 (55.8%) had relapsed/refractory disease. The ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%). Forty-seven (27.3%) patients had stem cell transplantation, and 59 (34.3%) were neutropenic. Of them, 143 (83.2%) patients were admitted to intensive care after intubation and 159 (92.4%) patients needed vasopressors during intensive care stay. Thirteen (7.5%) patients were diagnosed with fiberoptic bronchoscopy-bronchoalveolar lavage sampling only, and treatment was changed in 85% according to the results. We observed that the patients were admitted to the ICU at the 28th hour (11-55) after determining the need for ICU follow-up. Intensive care mortality was 94.3% (163).

Conclusion:

Early detection of critical illness and rapid admission to the ICU are important for the patients with HM. Collaborative studies determining early admission criteria to ICUs should be performed by the intensivists and hematologists to improve survival. This may be achieved by allocating special ICUs for these patients within the hematology clinics.

Keywords: Hematological malignancies, intensive care, mortality, admission time

References

  1. Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, et al. Improved survival in cancer patients requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support. Crit Care Med 2001;29:519-25.
  2. Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with hhematologicalmalignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth 2012;108:452-9.
  3. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. J Clin Oncol 2013;31:2810-8.
  4. Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, et al. Is intensive care justified for patients with haematological malignancies? Intensive Care Med 1990;16:291-7.
  5. Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, et al. Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 2002;28:1294-300.
  6. Demandt AMP, Geerse DA, Janssen BJP, Winkens B, Schouten HC, van Mook WNKA. The prognostic value of a trend in modified SOFA score for patients with hematological malignancies in the intensive care unit. Eur J Haematol 2017;99:315-22.
  7. de Vries VA, Müller MCA, Arbous MS, Biemond BJ, Blijlevens NMA, Kusadasi N, et al. Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care. Crit Care Med 2019;47:120-8.
  8. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, et al. Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 1999;25:1395-401.
  9. van Beers EJ, Müller MC, Vlaar AP, Spanjaard L, van den Bergh WM; HEMA-ICU Study Group. Haematological malignancy in the intensive care unit: microbiology results and mortality. Eur J Haematol 2016;97:271-7.
  10. Hui D, Didwaniya N, Vidal M, Shin SH, Chisholm G, Roquemore J, et al. Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer. 2014;120:1572-8.
  11. Odejide OO, Cronin AM, Condron NB, Fletcher SA, Earle CC, Tulsky JA, et al. Barriers to Quality End-of-Life Care for Patients With Blood Cancers. J Clin Oncol 2016;34:3126-32.
  12. Mokart D, Lambert J, Schnell D, Fouché L, Rabbat A, Kouatchet A, et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma 2013;54:1724-9.
  13. Azoulay E, Mokart D, Lambert J, Lemiale V, Rabbat A, Kouatchet A, et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010;182:1038-46.
  14. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801-10.
  15. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-21.
  16. Maqsood S, Badar F, Hameed A. Characteristics and Outcomes of Patients with Hematological Malignancies Admitted for Intensive Care - a Single Centre Experience. Asian Pac J Cancer Prev 2017;18:1833-7.
  17. Irie H, Otake T, Kawai K, Hino M, Namazu A, Shinjo Y, et al. Prognostic factors in critically ill patients with hematological malignancy admitted to the general intensive care unit: a single-center experience in Japan. J Anesth 2017;31:736-43.
  18. Evison J, Rickenbacher P, Ritz R, Gratwohl A, Haberthür C, Elsasser S, et al. Intensive care unit admission in patients with haematological disease: incidence, outcome and prognostic factors. Swiss Med Wkly 2001;131:681-6.
  19. Depuydt PO, Benoit DD, Roosens CD, Offner FC, Noens LA, Decruyenaere JM. The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure. J Crit Care 2010;25:30-6.
  20. Al-Zubaidi N, Shehada E, Alshabani K, ZazaDitYafawi J, Kingah P, Soubani AO. Predictors of outcome in patients with hematologic malignancies admitted to the intensive care unit. Hematol Oncol Stem Cell Ther 2018;11:206-18.
  21. Legrand M, Max A, Peigne V, Mariotte E, Canet E, Debrumetz A, et al. Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med 2012;40:43-9.
  22. Cordonnier C, Cesaro S, Maschmeyer G, Einsele H, Donnelly JP, Alanio A, et al. Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother 2016;71:2379-85.
  23. Chan ST, Logan AC. The clinical impact of cytomegalovirus infection following allogeneic hematopoietic cell transplantation: Why the quest for meaningful prophylaxis still matters. Blood Rev 2017;31:173-83.
  24. Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care 2011;15:28.
  25. Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, et al. Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds. Crit Care Med 2004;32:1654-61.
  26. Stohl S, Sprung CL, Lippert A, Pirracchio R, Artigas A, Iapichino G, et al. Impact of triage-to-admission time on patient outcome in European intensive care units: A prospective, multi-national study. J Crit Care 2019;53:11-7.
  27. Kalicińska E, Kuszczak B, Dębski J, Szukalski Ł, Wątek M, Strzała J, et al. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit? Support Care Cancer 2021;29:323-30.
  28. Beaussant Y, Daguindau E, Chauchet A, Rochigneux P, Tournigand C, Aubry R, et al. Hospital end-of-life care in haematological malignancies. BMJ Support Palliat Care 2018;8:314-24.

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Küçük M, Öztürk MC, Yavuz B, Ergün B, Yakar MN, Cömert B, et al. Evaluation of Patients with Hematological Malignancies Admitted to the General Intensive Care Unit - Should There be Dedicated Hematological ICUs?. Turk J Intensive Care. 2023;21(1):16-24. https://doi.org/10.4274/tybd.galenos.2022.38358