Naslov
Outcome predictors in hematologic malignancies in ICU

Autori
Gašparović, Vladimir ; Gornik, Ivan ; Oršulić, Ana ; Ilić, Mario

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Abstracts of the 4th Central European Congress of Intensive Care Medicine (CECIM 2008) : 140th Anniversary of Novel Laureate Dr. Karl Landsteiner ; u: Wiener klinische Wochenschrift 120 (2008) (S3) (S1-S60 / - , 2008, S11-S12

Skup
Central European Congress of Intensive Care Medicine : 140th Anniversary of Novel Laureate Dr. Karl Landsteiner (4 ; 2008)

Mjesto i datum
Baden, Austrija, 24.10.2008. - 25.10.2008

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
outcome; hematologic malignancies; ICU

Sažetak
Development of complications and/or progression of complications in the patients with haematologic malignancies often lead to unfavourable outcomes in ICU. Reasons for ICU admission of patients with malignant neoplasm of haematopoietic system most frequently are severe sepsis and septic shock and organ failures. Fundamental question which emerges from everyday practice is: “When is it most favourable to admit those patients to an ICU and to initiate organ replacement treatments regarding their short and long term outcomes?” The study included patients with haematologic malignancies admitted to Medical ICU, University Hospital. Inclusion criteria were: adult age (≥ 18 years), failure of at least one organ system. Severity of illness was classified by Simplified Acute Physiology (SAPS II) Score and Karnofsky performance score (KPS). Outcome measures were: 28-day survival and survival at discharge from the hospital. Potential predictors of mortality: patient’s age and sex, underlying haematological malignancy, type of previous treatment, type of organ failure, time from occurrence of respiratory failure to initiation of respiratory support, SAPS II and KPS scores at ICU admission. MedCalc™ statistical software was used for statistical analyses. Categorical variables are presented as absolute and relative frequencies, continuous variables as medians with ranges. Logistic regression was used in multivariate analysis of potential independent predictors of outcome. Respiratory failure with or without neutropenia in patients with malignant haematology diseases is commonly a consequence of sepsis. Respiratory failure is occurring either as a consequence of severe bacterial or fungal pneumonias or often fatal viral interstitial pneumonias. Acute respiratory distress syndrome (ARDS) is also often contributing or even major causative factor in respiratory failure. Renal failure is also very common, and can exist as a part of severe sepsis, or a consequence of nephrotoxic drugs. Differently from some centres that advocate non-invasive mechanical ventilation as the first method of respiratory support with endotracheal intubation as a back-up in case of further respiratory deterioration, our patients were firstly intubated and ventilated. High mortality of such patients led to evaluation of potential outcome predictors at the time of ICU admission. It has been shown that respiratory failure and haemodynamic parameters significantly influence prognosis, while age, sex and primary haematological disease had not influence. These data are in concordance with a part of our results where respiratory failure, SAPS II score and platelet count were shown to be predictors. Low leukocyte count, shown to be the best predictor of mortality was not confirmed as such in our study. Higher mortality rates in our patients could partly be explained by late referral to the ICU, when organ failure has progressed so much that it already needed organ support or organ replacement therapies. Most of our patients were for instance mechanically ventilated within the firs hour of ICU admission. High SAPS II score at the moment of ICU admission (higher than SAPS II score reported in other papers) can also confirm relatively late timing or ICU admission. Earlier admission of patients with haematological malignancies and deterioration in organ function, especially respiratory failure may very much improve survival. Non-invasive mechanical ventilation could than be used more frequently and more successfully. ICU admission and treatments with organ supportive therapies can lead them through this high risk period and give them a chance of recovery and long term survival.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti

POVEZANOST RADA