Abstract
Background and Objectives: Oncohematological patients have a high risk of mortality when they need treatment in an intensive care unit (ICU). The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the ICU and their risk factors. Materials and Methods: A prospective single-center observational study was performed with 114 patients from July 2017 to December 2019. Inclusion criteria were transfer to an ICU, hematological malignancy, age >18 years, a central line or arterial line inserted or planned to be inserted, and a signed informed consent form. Univariate and multivariable logistic regression models were used to evaluate the potential risk factors for ICU mortality. Results: ICU mortality was 44.74%. Invasive mechanical ventilation in ICU was used for 55.26% of the patients, and vasoactive drugs were used for 77.19% of patients. Factors independently associated with it were qSOFA score ≥2, increase of SOFA score over the first 48 h, mechanical ventilation on the first day in ICU, need for colistin therapy, lower arterial pH on arrival to ICU. Cut-off value of the noradrenaline dose associated with ICU mortality was 0.21 μg/kg/min with a ROC of 0.9686 (95% CI 0.93–1.00, p < 0.0001). Conclusions: Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. Despite our findings, we do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline.
Highlights
The incidence of malignancies is increasing in Lithuania [1] and more than one thousand people are diagnosed with blood cancer every year [2]
The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the intensive care unit (ICU) and their risk factors
The aim of our study is to analyze the outcomes of oncohemathological patients who are admitted to ICU and their risk factors
Summary
The incidence of malignancies is increasing in Lithuania [1] and more than one thousand people are diagnosed with blood cancer every year [2]. Data show that survival of patients with hematological malignancies has increased dramatically over the last few decades [6,7,8] including patients admitted to the ICU [9]. It is better in Western Europe than in Eastern Europe [10,11,12] which is still suffering from less effective care, fewer resources allocated to heath care [13], limited access to innovative treatment options, higher out-of-pocket spending on health [14,15], and differences in the setting of end of life which makes comparison of survival difficult. Conclusions: Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. We do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline
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