PMID- 22298243
OWN - NLM
STAT- MEDLINE
DCOM- 20120410
LR  - 20220408
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 108
IP  - 3
DP  - 2012 Mar
TI  - Outcomes and prognostic factors in patients with haematological malignancy 
      admitted to a specialist cancer intensive care unit: a 5 yr study.
PG  - 452-9
LID - 10.1093/bja/aer449 [doi]
AB  - BACKGROUND: Long-held assumptions of poor prognoses for patients with 
      haematological malignancies (HM) have meant that clinicians have been reluctant 
      to admit them to the intensive care unit (ICU). We aimed to evaluate ICU, 
      in-hospital, and 6 month mortality and to identify predictors for in-hospital 
      mortality. METHODS: A cohort study in a specialist cancer ICU of adult HM 
      patients admitted over 5 yr. Data acquired included: patient characteristics, 
      haematological diagnosis, haematopoietic stem cell transplant (HSCT), reason for 
      ICU admission, and APACHE II scores. Laboratory values, organ failures, and level 
      of organ support were recorded on ICU admission. Predictors for in-hospital 
      mortality were evaluated using uni- and multivariate analysis. RESULTS: Of 199 
      patients, median age was 58 yr [inter-quartile range (IQR) 46-66], 51.7% were 
      emergency admissions, 42.2% post-HSCT, 51.9% required mechanical ventilation, 
      median APACHE II was 21 (IQR 16-25), and median organ failure numbered 2 (IQR 
      1-4). ICU, in-hospital, and 6 month mortalities were 33.7%, 45.7%, and 59.3%, 
      respectively. Univariate analysis revealed bilirubin >32 micromol litre(-1), 
      mechanical ventilation, >/=2 organ failures, renal replacement therapy, vasopressor 
      support (all P<0.001), graft-vs-host disease (P=0.007), APACHE II score (P=0.02), 
      platelets </=20x10(9) litre(-1) (P=0.03), and proven invasive fungal infection 
      (P=0.04) were associated with in-hospital mortality. Multivariate analysis 
      revealed that >/=2 organ failures [odds ratio (OR) 5.62; 95% confidence interval 
      (95% CI), 2.30-13.70] and mechanical ventilation (OR 3.03; 95% CI, 1.33-6.90) 
      were independently associated with in-hospital mortality. CONCLUSIONS: Mortality 
      was lower than in previous studies. Mechanical ventilation and >/=2 organ failures 
      were independently associated with in-hospital mortality. 'Traditional' variables 
      such as neutropenia, transplantation status, and APACHE II score no longer appear 
      to be predictive.
FAU - Bird, G T
AU  - Bird GT
AD  - Department of Anaesthesia and Intensive Care, The Royal Marsden NHS Foundation 
      Trust, Fulham Road, London SW3 6JJ, UK.
FAU - Farquhar-Smith, P
AU  - Farquhar-Smith P
FAU - Wigmore, T
AU  - Wigmore T
FAU - Potter, M
AU  - Potter M
FAU - Gruber, P C
AU  - Gruber PC
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20120131
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
CIN - Br J Anaesth. 2012 Aug;109(2):291-2. PMID: 22782986
MH  - Aged
MH  - England/epidemiology
MH  - Female
MH  - Hematologic Neoplasms/complications/diagnosis/mortality/*therapy
MH  - Hematopoietic Stem Cell Transplantation
MH  - Hospital Mortality
MH  - Hospitalization
MH  - Humans
MH  - *Intensive Care Units
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - *Oncology Service, Hospital
MH  - Prognosis
MH  - Respiration, Artificial
MH  - Severity of Illness Index
MH  - Transplantation Conditioning/methods
MH  - Treatment Outcome
EDAT- 2012/02/03 06:00
MHDA- 2012/04/11 06:00
CRDT- 2012/02/03 06:00
PHST- 2012/02/03 06:00 [entrez]
PHST- 2012/02/03 06:00 [pubmed]
PHST- 2012/04/11 06:00 [medline]
AID - S0007-0912(17)32310-3 [pii]
AID - 10.1093/bja/aer449 [doi]
PST - ppublish
SO  - Br J Anaesth. 2012 Mar;108(3):452-9. doi: 10.1093/bja/aer449. Epub 2012 Jan 31.