Hematologic malignancies in the medical intensive care unit - Outcomes and prognostic factors

被引:32
作者
Medic, Marijana Grgic [1 ]
Gornik, Ivan [1 ,2 ]
Gasparovic, Vladimir [1 ,2 ]
机构
[1] Univ Hosp Ctr Zagreb, Dept Med, Intens Care Unit, Zagreb 10000, Croatia
[2] Univ Zagreb, Sch Med, Zagreb 41001, Croatia
关键词
Hematologic malignancies; ICU; Mechanical ventilation; Mortality; ACUTE RESPIRATORY-FAILURE; CRITICALLY-ILL PATIENTS; STEM-CELL TRANSPLANTATION; NONINVASIVE VENTILATION; CANCER-PATIENTS; MECHANICAL VENTILATION; IMPROVED SURVIVAL; RANDOMIZED-TRIAL; SEPTIC SHOCK; SUPPORT;
D O I
10.1179/1607845414Y.0000000206
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To analyze clinical characteristics, treatment, outcomes of critically ill patients with hematologic malignancies (HM) admitted to the medical intensive care unit (ICU) and to identify predictors of adverse outcome. Methods: We analyzed prospectively 170 patients. Data included: demographic characteristics, hematologic diagnosis, reasons for ICU admission, transplant status, the presence of neutropenia, acute physiology and chronic health evaluation-II and sequential organ failure assessment scores, and level of organ support. Predictors of ICU mortality were evaluated using univariate and multivariate analysis. Results: In total, 73% of patients had high-grade malignancy, 47.6% received intensive chemotherapy before admission, and 30% underwent hematologic stem cell transplantation procedure. In total, 116 (68.2%) of patients were mechanically ventilated; 88 (51.8%) required invasive mechanical ventilation (MV). Noninvasive ventilation started in 28 (16.5%) patients and was successful in 11 (6.5%). The ICU mortality rate was 53.5%, and the mortality of MV patients was 75.9%. Need for vasopressors at admission and MV were identified as independent predictors of fatal outcome. Conclusion: The ICU mortality of critically ill patients with HM is high, particularly in the group of MV. Need for vasopressors at admission and MV were independent predictors of ICU mortality. Majority of patients required invasive MV due to severe respiratory failure and non-invasive MV was sufficient only in small number of cases with favorable outcome.
引用
收藏
页码:247 / 253
页数:7
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