Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis

// Etienne Faucher 1, 2 , Martin Cour 1, 2 , Vincent Jahandiez 1, 2 , Adeline Grateau 1 , Thomas Baudry 1 , Romain Hernu 1 , Marie Simon 1 , Jean-michel Robert 1 , Mauricette Michallet 2, 3 , Laurent Argaud 1, 2 1 Hospices civils de Lyon, Groupement hospitalier Edouard Herriot, Service de reanimation medicale, F-69003, Lyon, France 2 Universite de Lyon, Universite Lyon 1, Faculte de medecine Lyon Est, F-69008, Lyon, France 3 Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service d’hematologie, F-69310, Pierre-Benite, France Correspondence to: Laurent Argaud, e-mail: laurent.argaud@chu-lyon.fr Keywords: hematological malignancy, allogeneic hematopoietic stem cell transplantation, neutropenia, invasive mechanical ventilation, intensive care unit Received: October 29, 2016      Accepted: February 23, 2016      Published: March 8, 2016 ABSTRACT Although the overall mortality of patients admitted to intensive care units (ICU) with hematological malignancy has decreased over the years, some groups of patients still have low survival rates. We performed a monocentric retrospective study including all patients with hematological malignancy in a ten-year period, to identify factors related to the outcome for the whole cohort and for patients with allogeneic hematopoietic stem cell transplantation (HSCT), neutropenia, or those requiring invasive mechanical ventilation (IMV). A total of 418 patients with acute leukemia (n=239; 57%), myeloma (n=69; 17%), and lymphoma (n=53; 13%) were studied. Day-28 and 1-year mortality were 49% and 72%, respectively. The type of disease was not associated with outcome. The disease status was independentlty associated with 1-year mortality only. Independent predictors of day-28 mortality were IMV, renal replacement therapy (RRT), and performance status. For allogeneic HSCT recipients (n=116), neutropenic patients (n=124) and patients requiring IMV (n=196), day-28 and 1-year mortality were 52%, 54%, 74% and 81%, 78%, 87%, respectively. Multivariate analysis showed that IMV and RRT for allogeneic HSCT recipients, performance status and IMV for neutropenic patients, and RRT for patients requiring IMV were independently associated with short-term mortality (p<0.05). These results suggest that IMV is the strongest predictor of mortality in hematological patients admitted to ICUs, whereas allogeneic HSCT and neutropenia do not worsen their short-term outcome.