Outcomes and Prognostic Factors in Critical Patients with Hematologic Malignancies

Author:

Chen Chieh-Lung1ORCID,Wang Sing-Ting2,Cheng Wen-Chien13456ORCID,Wu Biing-Ru17,Liao Wei-Chih138,Hsu Wu-Huei19

Affiliation:

1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan

2. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan

3. School of Medicine, China Medical University, Taichung 404, Taiwan

4. Department of Life Science, National Chung Hsing University, Taichung 402, Taiwan

5. Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan

6. Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan

7. Department of Respiratory Therapy, China Medical University Hospital, Taichung 404, Taiwan

8. Center for Hyperbaric Oxygenation Therapy, China Medical University Hospital, Taichung 404, Taiwan

9. Critical Medical Center, China Medical University Hospital, Taichung 404, Taiwan

Abstract

Patients with hematologic malignancies (HMs) have a significantly elevated risk of mortality compared to other cancer patients treated in the intensive care unit (ICU). The prognostic impact of numerous poor outcome indicators has changed, and research has yielded conflicting results. This study aims to determine the ICU and hospital outcomes and risk factors that predict the prognosis of critically ill patients with HMs. In this retrospective study, conducted at a referral hospital in Taiwan, 213 adult patients with HMs who were admitted to the medical ICU were evaluated. We collected clinical data upon hospital and ICU admission. Using a multivariate regression analysis, the predictors of ICU and hospital mortality were assessed. Then, a scoring system (Hospital outcome of critically ill patients with Hematological Malignancies (HHM)) was built to predict hospital outcomes. Most HMs (76.1%) were classified as high grade, and more than one-third of patients experienced a relapsed or refractory disease. The ICU and hospital mortality rates were 55.9% and 71.8%, respectively. Moreover, the disease severity was high (median Sequential Organ Failure Assessment (SOFA) score: 11 and Acute Physiology and Chronic Health Evaluation (APACHE II) score: 28). The multivariate analysis revealed that high-grade HMs, invasive mechanical ventilation requirement, renal replacement therapy initiation in the ICU, and a high SOFA score correlated with ICU mortality. Furthermore, a higher HHM score predicted hospital mortality. This study demonstrates that ICU mortality primarily correlates with the severity of organ dysfunction, whereas the disease status markedly influences hospital outcomes. Furthermore, the HHM score significantly predicts hospital mortality.

Publisher

MDPI AG

Subject

General Medicine

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