Outcomes for haematological cancer patients admitted to an intensive care unit in a university hospital

• Published in: Australian critical care 2018-11, Vol.31 (6), p.363-368
• Main Authors: Alp, Emine, Tok, Tuğba, Kaynar, Leylagül, Cevahir, Fatma, Akbudak, İsmail Hakkı, Gündoğan, Kürşat, Çetin, Mustafa, Rello, Jordi
• Format: Article
• Language: English
• Subjects: Haematological cancer; Infection; Intensive care unit; Mortality; Nursing; Septic shock
• ISSN: 1036-7314; 1878-1721
• DOI: 10.1016/j.aucc.2017.10.005

Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients’ re-assessment for support. Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients’ data were collected from medical records and Infection Control Committee surveillance reports. Logistic regression analysis was performed to identify independent risk factors for ICU mortality. Sixty-one were neutropenic, and 99 (88%) had infection at ICU admission. Acute myeloid leukaemia was diagnosed in 43%. Thirty-five (31%) were hematopoietic stem cell transplant recipients. Only 17 (15%) were in remission. Eighty-nine underwent mechanical ventilation on admission. Fifty-three patients acquired ICU-infection (35 bacteremia) being gram negative bacteria (Klebsiella pneumoniae and non-fermenters) the top pathogens. However, ICU-acquired infection had no impact on mortality. The overall ICU and 1-year survival rate was 27% (30 patients) and 7% (8 patients), respectively. Moreover, only 2/62 patients survived with APACHE II score ≥25. The median time for death was 4 days. APACHE II score ≥25 [OR:35.20], septic shock [OR:8.71] and respiratory failure on admission [OR:10.55] were independent risk factors for mortality in multivariate analysis. APACHE II score ≥25 was a strong indicator for poor outcome (ROC under curve 0.889). APACHE II score ≥25 and septic shock were criteria of ICU futility. Our findings support the full support of patients for 5 days and the need to implement a therapeutic limitations protocol.