Characteristics and outcomes of haematology patients admitted to the intensive care unit

Abstract

To profile the characteristics and outcomes of adult haematology patients admitted to the intensive care unit (ICU). The role of intensive care support for haematology patients is contentious due to high mortality rates thus generating debate regarding the inappropriate use of limited resources versus denial of effective care. Medical notes, laboratory records and Intensive Care National Audit and Research Centre (ICNARC) data for all adult haematology patients admitted to Belfast City Hospital ICU in 2009 were analysed. Twenty one patients were admitted to the ICU; mean age was 56 years (SD 12·5), 52% were male and 82% (n=19) had a malignant diagnosis. The main indication for admission was neutropenic sepsis with associated organ impairment (n=18, 85%). ICU mortality was 43%. Three-month and six-month mortality rates were 62% and 67%, respectively. ICU survivors had lower acute physiology and chronic health evaluation (APACHE II) scores, and decreased requirements for invasive ventilation and inotropic support. Of the post-six-month survivors, one had a relapse, one had responding disease and five remained in remission. Two patients have subsequently undergone a reduced intensity conditioning transplant. One third of patients survived for >6 months indicating that critically ill haematology patients can benefit from ICU admission, allowing progression to potentially curative therapies. This study highlights the necessity of individualized assessment regarding patient suitability for admission to a critical care facility, incorporating the perspective of both the haematologist and the intensivist.