Abstract
BackgroundEpidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure.MethodsPost hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010–2012). The primary outcome was vital status at hospital discharge.ResultsOf the 1011 patients enrolled initially, 226 (22.4%) had neurological failure. Presenting manifestations were dominated by drowsiness or stupor (65%), coma (32%), weakness (26%), and seizures (19%). Neuroimaging, lumbar puncture, and electroencephalography were performed in 113 (50%), 73 (32%), and 63 (28%) patients, respectively. A neurosurgical biopsy was done in 1 patient. Hospital mortality was 50%. By multivariate analysis, factors independently associated with higher hospital mortality were poor performance status (odds ratio [OR], 3.99; 95%CI, 1.82–9.39; P = 0.0009), non-Hodgkin’s lymphoma (OR, 2.60; 95%CI, 1.35–5.15; P = 0.005), shock (OR, 1.95; 95%CI, 1.04–3.72; P = 0.04), and respiratory failure (OR, 2.18; 95%CI, 1.14–4.25; P = 0.02); and factors independently associated with lower hospital mortality were GCS score on day 1 (OR, 0.88/point; 95%CI, 0.81–0.95; P = 0.0009) and autologous stem cell transplantation (OR, 0.25; 95%CI, 0.07–0.75; P = 0.02).ConclusionsIn ICU patients with hematological malignancies, neurological failure is common and often fatal. Independent predictors of higher hospital mortality were type of underlying hematological malignancy, poor performance status, hemodynamic and respiratory failures, and severity of consciousness impairment. Knowledge of these risk factors might help to optimize management strategies.
Highlights
Recent advances in the management of hematological malignancies,[1] including the introduction of new drugs, have improved survival and changed the circumstances of admission to the intensive care unit (ICU)
Independent predictors of higher hospital mortality were poor performance status (OR, 3.99; 95% confidence intervals (95%CI), 1.82–9.39; P = 0.0009), non-Hodgkin’s lymphoma (OR, 2.60; 95%CI, 1.35–5.15; P = 0.005), shock (OR, 1.95; 95%CI, 1.04–3.72; P = 0.04), and respiratory failure (OR, 2.18; 95%CI, 1.14–4.25; P = 0.02)
Factors associated with lower hospital mortality were a higher Glasgow Coma Scale (GCS) score on day 1 (OR, 0.88/point; 95%CI, 0.81–0.95; P = 0.0009) and autologous stem cell transplantation (OR, 0.25; 95%CI, 0.07–0.75; P = 0.02)
Summary
Recent advances in the management of hematological malignancies,[1] including the introduction of new drugs, have improved survival and changed the circumstances of admission to the intensive care unit (ICU). Epidemiological studies of neurological complications in patients with hematological malignancies are scant and generally relied on retrospective data collection. Few of them focused on severe complications requiring admission to the ICU,[10] which were found to carry a hospital mortality rate of 45%.[10] Further information would help clinicians to identify those patients most likely to benefit from aggressive diagnostic and therapeutic strategies. Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure
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