Outcomes of Critically Ill Patients With Hematologic Malignancies: Prospective Multicenter Data From France and Belgium—A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study

Abstract

Purpose Patients with hematologic malignancies are increasingly admitted to the intensive care unit (ICU) when life-threatening events occur. We sought to report outcomes and prognostic factors in these patients. Patients and Methods Ours was a prospective, multicenter cohort study of critically ill patients with hematologic malignancies. Health-related quality of life (HRQOL) and disease status were collected after 3 to 6 months. Results Of the 1,011 patients, 38.2% had newly diagnosed malignancies, 23.1% were in remission, and 24.9% had received hematopoietic stem-cell transplantations (HSCT, including 145 allogeneic). ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%). On day1, 733 patients (72.5%) received life-supporting interventions. Hospital, day-90, and 1-year survival rates were 60.7%, 52.5%, and 43.3%, respectively. By multivariate analysis, cancer remission and time to ICU admission less than 24 hours were associated with better hospital survival. Poor performance status, Charlson comorbidity index, allogeneic HSCT, organ dysfunction score, cardiac arrest, acute respiratory failure, malignant organ infiltration, and invasive aspergillosis were associated with higher hospital mortality. Mechanical ventilation (47.9% of patients), vasoactive drugs (51.2%), and dialysis (25.9%) were associated with mortality rates of 60.5%, 57.5%, and 59.2%, respectively. On day 90, 80% of survivors had no HRQOL alterations (physical and mental health similar to that of the overall cancer population). After 6 months, 80% of survivors had no change in treatment intensity compared with similar patients not admitted to the ICU, and 80% were in remission. Conclusion Critically ill patients with hematologic malignancies have good survival, disease control, and post-ICU HRQOL. Earlier ICU admission is associated with better survival.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…Hospital mortality, 90-day and 1-year mortality rates of critically ill patients with hematological malignancies were 39%, 48% and 57% respectively. 10 These results are encouraging, particularly as most patients had at least 2 organ dysfunctions, and 75% required MV, vasoactive drugs or renal replacement therapy. These results justify the use of ICU resource in hematologic patients.…”

“…8,9 Recent data support the use of ICU resources in these patients, with dramatically decreased mortality rates and long-term benefits. [10][11][12] Whether these trends are confirmed in allo-HSTC patients is more controversial. 13,14 Considering all recent advances in HSCT techniques and ICU management, the reappraisal of actual prognosis became crucial to identify patients who are most likely to benefit from ICU support.…”

“…10,24 MOF at ICU admission appears as the main prognostic factor, especially when MV is required with almost a 100% mortality rate, 13 and no progress has been accomplished in the past decade in this situation. 20,24 Severity scores reflecting organ dysfunctions, such as APACHE II, APACHE III, SOFA and SAPSII, can help in severity assessment 19,24,30,31 but have not been validated in allo-HSCT patients.…”

“…Azoulay et al 10 recently reported outcomes of 1011 critically ill hematologic patients, including 14% of allo-HSCT patients. Hospital mortality, 90-day and 1-year mortality rates of critically ill patients with hematological malignancies were 39%, 48% and 57% respectively.…”

Improved outcome of critically ill patients with hematological malignancies: what’s next?

“…The study by van Vliet and colleagues represents an important step in this direction. Similar milestone studies have been published from France and Belgium and from Brazil [9,10]. However, more studies are needed which provide more insight into the role of type and status of malignancy, the timing and reason for admission to the ICU and the nature and number of organ failure in predicting the outcome of ICU admission.…”