Outcome and prognostic factors of patients with acute leukemia admitted to the intensive care unit for septic shock

Abstract

The purpose of the present study was to evaluate outcomes and identify prognostic factors in patients with acute leukemia who were admitted to the intensive care unit (ICU) with septic shock. Medical records of 50 patients with acute leukemia who were treated for septic shock in the Medical ICU of Samsung Medical Centre between September 2001 and June 2006 were retrospectively reviewed. The data were analysed for patient outcomes and for predictors of ICU mortality. ICU mortality and in-hospital mortality were 60% and 68%, respectively. The need for mechanical ventilation (p<0.001), the addition of norepinephrine to dopamine (p<0.001) and a poor Sequential Organ Failure Assessment (SOFA) score (p<0.001) were associated with ICU mortality in the univariate analysis. In the multivariate analysis using the Cox-model, a relapsed/refractory status for leukemia and poor SOFA score were independent predictors for ICU mortality. In conclusion, although the mortality was high in patients with acute leukemia who were admitted to the ICU for septic shock management, it was not high enough to preclude intensive care. Patients with severe organ failure and a relapse/refractory status for leukemia had a significantly worse prognosis.

Outcomes and changes in code status of patients with acute myeloid leukemia undergoing induction chemotherapy who were transferred to the intensive care unit

“…Our multivariate analysis showed that the type of AML (de novo or therapy related), use of mechanical ventilation, use of vasopressors, and response to therapy were the only significant factors that predicted hospital mortality for the entire cohort. The use of mechanical ventilation and vasopressors were associated with poor outcomes in our study which is consistent with previous studies [9–11]. This remained true in the cohort of patients who remained Full code or DNR indicating that despite the continuation of aggressive care if these interventions are needed outcomes are poor.…”

“…The hospital mortality for the entire cohort was 71% which is similar to previous studies for AML patients requiring ICU level care [8, 9]. If the patients who were made comfort care were excluded, hospital mortality dropped to 41%.…”

Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit

“…Major organ involvement was defined as a pathologically confirmed or radiologically suspected invasion of the brain, heart, lung, liver, or kidney [8]. Severe neutropaenia was defined by an absolute neutrophil count (ANC)<0.5×10 3 /µl [9].…”

Evaluation of D-dimer and lactate dehydrogenase plasma levels in patients with relapsed acute leukemia

“…LDH exists in numerous cell systems and, subsequent to tissue or cell damage, serum LDH levels may increase (15). Although it is generally understood that there is a poor outcome for adults with AL that develop bone marrow relapse (16) and various risk factors predicting outcome are continuously analyzed, there are few studies concerning LDH and D-dimer in these types of patients. The present study was performed to determine whether D-dimer and LDH levels during treatment are associated with relapse in patients with AL.…”