PURPOSE: Identification of the prognostic factors associated with mortality in a immunossupressed patients (IP) admitted in medical intensive care unit (ICU).
METHODS: All IP admitted in the ICU between January 1st 2005 and December 31st 2006 were reviewed. Demographic factors, admision diagnosis (AD), immunosuppression etiology (IE), severity scores (APACHE II, SAPS II), P02/Fi02 ratio, number of organ failure at admission (NOFA), conventional mechanical ventilation, non-invasive ventilation and mortality were get in. Patients with acute coronary syndrome, patients without tumoral grown evidence in the last 5 years and those that were in the postoperatory period of tumoral resection were excluded.
RESULTS: In the study period 2042 patients were admitted, 49 of them were IP and they had the following characteristics: 30 men (61,22%) and 19 woman (38,78%), aged 62.1±15.7, APACHE II 22.65±8, SAPS II 55.65±27, P02/Fi02 176.65±82, NOFA 2.59±1.22, VM 67.3%, VNI 22.4%, mortality was 26.5% (n 13). Immunossupresion origin was 53,1% solid organ cancer, 14.2% haematology disease, 12.2% immunologic disease under immunossupresor treatment (methotrexate or cyclophosphamide), 10.2% were treated with corticosteroids, 6.1% were organ transplant recipients under immunossupresor treatment, and 4.1% were VIH. AD in ICU was: 44.9% acute respiratory failure, 26.5% septic shock, 16.3% neurological cause, 12.3% others (hemorrhagic and distributive shock). Mortality was related with the higger APACHE II (29,08 vs 20.33, p=0.001), the higger SAPS II (71,62 vs 57,08, p=0.004), higger NOFA (p=0.001). There was not relationship with sex (p=0.741), age (65.46 vs 60.89, p=0.454), P02/Fi02 (143.46 vs 188.64, p=0.1), AC (Chi2=0.879, p=0.830), immunosuppression etiology (Chi2=0.404, p=0.132), nor mechanical ventilation received (Chi2=0.4, p=0.132). Multivariant analysis related mortality with NOFA (p=0.16) and APACHE II (p=0.16). For every organ failure probability of death is increased a 270% [OR=2.7(IC95%;1.2–6.2)].
CONCLUSION: Two prognostic factors were associated with mortality in immunossupressed patients admitted in ICU, they are the number of organ failures and the higger APACHE II score.
CLINICAL IMPLICATIONS: Early ICU admission of immunosuppressed ill critical patients could improve their outcome.
DISCLOSURE: Jorge Sinclair-Avila, None.