Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit

Background: Mortality of patients with haematological malignancies requiring intensive therapy is high. We wanted to establish reasons for intensive care unit (ICU) admission and treatment as well as outcome in subjects who required invasive mechanical ventilation. We were also interested in differences between ICU survivors and non-survivors at the moment of admission. Patients and methods: Forty patients ( 21 women and 19 men) were included in the study. Median of age was 42 ( range 16 - 73) years. All patients required mechanical ventilation. We analysed age, gender, disease character (acute/ chronic), diagnosed pneumonia, multiple organ failure (MOF), history of bone marrow transplantation, peripheral blood parameters ( leukocyte, neutrocyte, erythrocyte and thrombocyte counts, haemoglobin level and haematocrit), mean arterial pressure ( obtained through direct measurement), necessity of catecholamine administration and symptoms of the acute renal insufficiency at the moment of ICU admission. Main results: Sixty-five percent of patients died in ICU. Intergroup comparisons between survivors and non-survivors revealed statistically significant differences in the presence of neutropenia, thrombocyte count, mean arterial pressure and the necessity of catecholamines administration, as well as scores obtained through patient evaluation according to the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment ( SOFA) and the New Simplified Acute Physiology Score ( SAPS II) scales. Multivariate logistic regression revealed only one independent risk factor for ICU mortality in the analysed group - SAPS II score ( p= 0.009). Calculated value of the unitary odds ratio was 1.065 (95% confidence interval 1.017 - 1.116). Conclusions: Mortality of patients with haematological malignancies requiring intensive mechanical ventilation remains high. Scoring with the SAPS II system was a useful tool for determination of ICU mortality risk in those patients.