The prognostic factors for patients with hematological malignancies admitted to the intensive care unit

Cheng, Qian; Tang, Yawen; Yang, Qing; Wang, Erhua; Liu, Jing; Li, Xin

doi:10.1186/s40064-016-3714-z

Cited by 13 publications

(12 citation statements)

References 82 publications

(126 reference statements)

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“…Escalation has been described by others as complex and emotive ( Hill, 2010 ), with tensions potentially arising between clinicians due to differing perceptions of risk and benefit, as noted by our interviewees. Difficulties arise because patients are generally severely ill on referral to critical care, and survival often poor ( Azoulay et al, 2015 ; Cheng et al, 2016 ; Hill, 2010 ). Although these issues have resulted in calls for timely communication and close collaboration between teams ( Cheng et al, 2016 ), a recent UK study suggests that the appropriateness of escalating care is often not considered until patients are acutely unwell and outreach teams intervene ( Pattison et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

McCaughan

Roman

Smith

et al. 2019

European Journal of Oncology Nursing

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PurposePatients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death.MethodQualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach.ResultsFive inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home.ConclusionsHospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.

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Section: Discussionmentioning

confidence: 99%

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

McCaughan

Roman

Smith

et al. 2019

European Journal of Oncology Nursing

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“…5 Most large epidemiologic studies report sepsis in combination with septic shock and do not address patients with cancer. [6][7][8][9] Some studies address critically ill patients with hematologic malignancies but not sepsis or septic shock, 11,12 whereas other reports that addressed septic shock in this population predated the latest 2016 international consensus definitions for sepsis and septic shock and thus used Sepsis-2 definitions. 13,14 Some studies included small cohorts or were spread over long periods, leading to time bias.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria

Manjappachar

Cuenca

Ramirez

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: To describe short-term outcomes and independent predictors of 28-dayx mortality in adult patients with hematologic malignancies and septic shock defined by the new Third International Consensus Definitions (Sepsis-3) criteria. Methods: We performed a retrospective cohort study of patients admitted to the medical ICU with septic shock from April 2016 to March 2019. Demographic and clinical features and short-term outcomes were collected. We used descriptive statistics to summarize patient characteristics, logistic regression to identify predictors of 28-day mortality, and Kaplan-Meier plots to assess survival. Results: Among the 459 hematologic patients with septic shock admitted to the ICU, 109 (23.7%) had received hematopoietic stem cell transplant. The median age was 63 years (range, 18–89 years), and 179 (39%) were women. Nonsurvivors had a higher Charlson comorbidity index (P=.007), longer length of stay before ICU admission (P=.01), and greater illness severity at diagnosis and throughout the hospital course (P<.001). The mortality rate at 28 days was 67.8% and increased with increasing sequential organ failure assessment score on admission (odds ratio [OR], 1.11; 95% CI, 1.03–1.20), respiratory failure (OR, 3.12; 95% CI, 1.49–6.51), and maximum lactate level (OR, 1.16; 95% CI, 1.10–1.22). Aminoglycosides administration (OR, 0.42; 95% CI, 0.26–0.69), serum albumin (OR, 0.51; 95% CI, 0.31–0.86), and granulocyte colony-stimulating factor (G-CSF) (OR, 0.40; 95% CI, 0.24–0.65) were associated with lower 28-day mortality. Life support limitations were present in 81.6% of patients at death. At 90 days, 19.4% of the patients were alive. Conclusions: Despite efforts to enhance survival, septic shock in patients with hematologic malignancies is still associated with high mortality rates and poor 90-day survival. These results demonstrate the need for an urgent call to action with higher awareness, including the further evaluation of interventions such as earlier ICU admission, aminoglycosides administration, and G-CSF treatment.

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“…Bloodstream infections (BSIs) is a leading type observed in neutropenic patients, accounting for approximately 11 -38% of infections [1,2]. In recent years, a clear trend from Gram-positive towards Gramnegative bacterial BSIs infection has been observed [3,4]. Among the bacteria, Escherichia coli is the most common pathogen causing BSIs.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Wang

Liu

Huang

et al. 2019

J Infect Dev Ctries

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Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders. Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated. Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group. Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.

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The prognostic factors for patients with hematological malignancies admitted to the intensive care unit

Cited by 13 publications

References 82 publications

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

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