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Critical Care: Critical Care Nonpulmonary |

The Clinical Outcomes in Critically Ill Patients With Hematologic Malignancies Admitted to the Intensive Care Unit FREE TO VIEW

Xubin Huang, MD; Jun Zhang, MD; Xinyan Huang, MD; Yanzhu Chen, MD; Mian Zeng, MD
Author and Funding Information

MICU, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A171. doi:10.1016/j.chest.2016.02.177
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SESSION TITLE: Critical Care Nonpulmonary

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: The prognosis of critically ill patients with hematologic malignancies admitted to the intensive care unit (ICU) is poor, though the outcome of these patients has been improving. This study aimed to evaluate the clinical outcomes and determine the predictors of 28-day mortality in critically ill patients with hematologic malignancies admitted to the ICU.

METHODS: This prospective, observational cohort study was performed in a tertiary university hospital. A total of 72 consecutive critically ill patients with hematologic malignancies admitted to the ICU during a 5-year period between July 2010 and June 2015 were studied. Multivariate logistic regression analysis was used to identify the independent predictors of 28-day mortality.

RESULTS: The median age was 47 y (range, 12-84 y; IQR, 33-58), and 73.6% of the patients were male. The median APACHE II score was 23 (range, 10-44). The 28-day mortality rate was 62.5%. Hematologic malignancies were newly diagnosed in 25 (34.7%) cases and leukemia were the most common hematologic malignancies (66.7%). 19 (26.4%) had undergone a prior hematopoietic stem cell transplantation. There were 32 (44.4%) cases of neutropenia and 29 (40.3%) cases occurred before admission to the ICU. Respiratory failure was the leading cause of admission (81.9 %), followed by shock (12.5 %). There were 27 (37.5%) cases of acute kidney injury during the ICU stay. 15 patients required exclusively non-invasive ventilation, 20 required exclusively invasive ventilation, 25 required both non-invasive and invasive ventilation, and 12 required only oxygen therapy. 36 (50.0 %) patients needed vasopressors, and 17 (23.6 %) received dialysis. In multivariate analysis, independent predictors associated with 28-day mortality were the concurrence of neutropenia (OR 6.90, P= 0.009, 95% CI 1.63-29.17), the need for invasive mechanical ventilaton (OR 0.42, P=0.005, 95% CI 0.13-0.77), and the need for vasopressors (OR 0.27, P= 0.000, 95% CI 0.13-0.57).

CONCLUSIONS: In this cohort of critically ill patients with hematologic malignancies, the independent predictors associated with 28-day mortality were the concurrence of neutropenia, the need for invasive mechanical ventilaton, and the need for vasopressors.

CLINICAL IMPLICATIONS: Neutropenia, respiratory or hemodynamic instability point to a poor outcome in critically ill patients with hematologic malignancies admitted to the ICU.

DISCLOSURE: The following authors have nothing to disclose: Xubin Huang, Jun Zhang, Xinyan Huang, Yanzhu Chen, Mian Zeng

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