PURPOSE: To evaluate the clinical characteristics and outcomes of critically ill patients with hematological diseases (HD) admitted to an oncological intensive care unit (ICU).
METHODS: Prospective observational study from October 2007 to April 2009 in the ICU of the Instituto Nacional de Cancerologia located in Mexico City. There were no interventions.Forty patients with HD were admitted to the ICU.Continuous variables are expressed as means ± standard deviation or as medians and interquartile ranges.Categorical variables are expressed as percentage. Student’s t-test was used to compare continuous variables. The usefulness of the Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) score to predict outcomes in these patients was evaluated by its discriminative capacity (area under the receiver operative characteristics [AUROCC]).
RESULTS: The mean age was 43 ± 65 years,20 patients were women.The major reason for ICU admission was severe sepsis and septic shock (55%).The mean length of stay for all patients in ICU was 3.30 ± 3.85 days. There were 34 patients (85%) who required invasive mechanical ventilation, with a median duration of two day (range 1 to 4 days).The most common HD were non-Hodgkin's lymphoma (42.5%) and acute lymphoblastic leukemia (27.5%). Most patients (72.5%) had received chemotherapy ≤ 4 weeks before ICU admission. Non-survivors had higher APACHE II, SAPS II and SOFA score compared with survivors (21.6±5.6 versus 13.6± 3.3, 53.6±13.1 versus 29.3±9.3 and 12.8±2.4 versus 6.2±4.1, respectively,p<0.001 ). An SOFA score higher than 11 points predicted a mortality rate of 88.8%. Thirty-one patients had three or more organ dysfunctions on the day of their admission to the ICU.The AUROCCs were 0.93 (95% CI 0.87-1) for SAPS II, 0.91 (95% CI 0.81-1) for SOFA score and 0.89 (95% CI 0.79-0.99) for APACHE II score, suggesting good level of discrimination for mortality prediction. The overall ICU mortality rate was 57.5 %.
CONCLUSIONS: The ICU mortality of critically ill patients with HD is high and mainly associated with severity of organ failures. In this group of patients the severity of illness scoring systems have good level of discrimination for mortality prediction.
CLINICAL IMPLICATIONS: This preliminary report suggests that the patients with HD should be admitted to ICU as early as possible before progression to multiple organ dysfunction because delayed admission to ICU is associated with a higher mortality.
DISCLOSURE: The following authors have nothing to disclose: Silvio Ñamendys-Silva, María González Herrera, Angel Herrera-Gómez
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