Prognosis of hematologic malignancies does not predict intensive care unit mortality.

OBJECTIVE: To evaluate the correlation between specific prognosis of hematologic malignancies on the one hand and intensive care unit and hospital mortality in critically ill patients with hematologic malignancies on the other hand. DESIGN: Observational study during a 10-yr period. SETTING: A 22-bed medical-surgical intensive care unit. PATIENTS: A total of 84 consecutive patients with nonterminal hematologic malignancies with medical complications requiring intensive care. INTERVENTIONS: None. MEASUREMENTS: Demographic factors, acute physiology and organ dysfunction scores, microbiology, therapeutic support, and hematologic factors data on admission and during the intensive care unit stay were collected, together with mortality follow-up. Based on specific-disease prognostic factors and related published survival curves, the prognosis of hematologic malignancies was assessed and defined as good, intermediate, or poor according to a 3-yr survival probability of >50%, 20-50%, or <20%, respectively. MAIN RESULTS: Prognosis of hematologic malignancies does not predict intensive care unit or hospital mortality and almost reaches significance for 6-mo mortality (53%, 71%, and 84% rate for patients with good, intermediate, and poor prognosis, respectively, p =.058), but it determines long-term survival (p =.008). Intensive care unit, hospital, and 6-mo overall mortality rates were 38%, 61%, and 75%, respectively. Using multivariate analysis, intensive care unit mortality was best predicted on admission by respiratory failure and fungal infection, whereas hospital mortality was predicted by the number of organ failures, the bone marrow transplant status, and the presence of fungal infection. The Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II had no prognostic value, whereas the difference of the Multiple Organ Dysfunction Score between at the time of admission and at day 5 allowed quick prediction of hospital mortality. Diseases with the poorest 6-mo prognosis were acute myeloid leukemia and non-Hodgkin lymphoma. CONCLUSION The severity of the underlying hematologic malignancies does not influence intensive care unit or hospital mortality. Short-term prognosis is exclusively predicted by acute organ dysfunctions and by a pathogen's aggressiveness. Therefore, reluctance to admit patients with nonterminal hematologic malignancies to the intensive care unit based only on the prognosis of their underlying hematologic malignancy does not seem justified

Sepsis and organ system failure are major determinants of post-intensive care unit mortality

Purpose: The aim of the study was to investigate predictors of post-intensive care unit (ICU) in-hospital mortality with special emphasis on the impact of sepsis and organ system failure. Methods: This study is a subanalysis of the database from the observational Sepsis Occurrence in Acutely Ill Patients study conducted in 198 ICUs in 24 European countries between May 1 and May 15, 2002. Potential predictors of post-ICU mortality were considered at 3 levels: admission status, procedures and therapy during the ICU stay, and status at ICU discharge. Results: Of the 3147 patients included in the Sepsis Occurrence in Acutely Ill Patients study, 1729 (54.9%) were discharged to the general floor (study group) and 125 of these died (overall post-ICU hospital mortality rate, 4%); 26 (20.8%) died already the first day on the floor. Nonsurvivors were older, had higher incidence of hematologic cancer and cirrhosis, and greater Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score on ICU admission; they were also more likely to have been admitted for medical reasons than survivors. In a multivariate forward stepwise logistic regression analysis, age, hematologic cancer, cirrhosis, simplified acute physiology score II on admission, medical admission, sepsis at any time during ICU stay, and organ dysfunction at ICU discharge were all independently associated with a greater risk of post-ICU death. Conclusions: This large international study identified not only age, medical admission, and preexisting comorbidities on ICU admission but also sepsis and organ system failure as important independent risk factors for in-hospital post-ICU death. © 2008 Elsevier Inc. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)

Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 ± 17.0 vs. 60.6 ± 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35–0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis. © 2018, The Author(s)