Interaction of increasing ICU survival and admittance policies in patients with hematologic neoplasms: A single center experience with 304 patients.

Abstract

We evaluated the development of ICU survival of patients with hematopoietic malignancies and discussed changes in admittance policies. We compared 166 patients treated between 2009 and 2012 with 138 patients treated between 2013 and 2016. Patient characteristics and outcome were analyzed. ICU survival was 45.2% in the first group and 66.7% in the second (P<0.0005). Infection (P=0.033), invasive ventilation (IMV) (P=0.014) and SOFA score at day 3 (SOFA-48h) (P=0.007) independently indicated worse ICU survival in the first group, IMV (P=0.013) and SOFA-48h (P=0.019) in the second group. The second group showed lower frequencies of infection (P=0.003), IMV (P<0.0005), need for vasopressors (P<0.0005) and RRT (P=0.021) at ICU admittance than the first. Further, the accumulation of hyperkaliemia, acidosis, low bicarbonate, high lactate and hypotension showed worse ICU survival in both groups and was lower in second group. ICU survival increased distinctly between 2009 and 2016. At ICU admittance, parameters showing severity of illness were less frequent in the second group. Our findings indicate general treatment improvements especially of infections and changes of admittance policies toward early ICU admittance during time.