Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit

Alan P Kraguljac,Gabriella Jacob,Michael Christian,Sangeeta Mehta,Narmin Ibrahimova,Danielle Croucher,Alex Kiss,Vikram Kumar,Mark D Minden

doi:10.1155/2016/3027656

Abstract

Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.

Highlights

Over the past several decades, steady advances in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) diagnostics, treatment regimens, and patient riskstratification protocols have led to increased survival rates [1,2,3,4,5]
acute leukemia (AL) patients admitted to the intensive care unit (ICU) had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission
ICU survival rates are increasing for cancer patients and in-hospital survival rates are similar to patients with other comorbidities such as liver cirrhosis or heart disease [4, 15]

Summary

Introduction

Over the past several decades, steady advances in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) diagnostics, treatment regimens, and patient riskstratification protocols have led to increased survival rates [1,2,3,4,5]. To improve AL survival rates intensive treatment regimens are used, which can lead to serious complications and admission to the intensive care unit (ICU). Due to the overall poor survival rates for AL patients, ICU admission for this population was largely considered futile, given concerns that critical care resources should be reserved for patients with a superior chance of survival. In order to further improve AL survival and inform the allocation of ICU resources, it is important to characterize ICU outcomes and identify predictors of patient outcome. This data may help inform clinicians, patients, and families and guide future critical care research in this vulnerable population

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Results

Conclusion