Pneumonia in neutropenic patients with haematologic malignancies and disorders: Frequency and predictors of ICU admission at a tertiary care hospital in Karachi, Pakistan

Abstract

Introduction: Neutropenia is a common manifestation of haematologic malignancies and disorders ; either due to the disease process itself or chemotherapy. Patients with neutropenia are at a high risk of developing severe pneumonia with life threatening complications and admission in a critical care unit. Objective: To determine the frequency and risk factors for ICU admission in neutropenic adults with haematological malignancies and disorders admitted with pneumonia. Materials and Methods: A retrospective cross-sectional survey was done. Data from January, 2011 to December, 2015 was collected on 111 neutropenic patients with haematologic malignancies. Results: 111 patients were enrolled ; 65.8%(n=73) were male and acute myeloid leukemia ,the most common pathology(n=40). The average age was 45.8±17.9 yrs. 42.3% (n=47) required ICU admission. 24 were managed on non-invasive ventilation(NIMV) and 23 patients required invasive mechanical ventilation (9 electively intubated and 14 failing NIMV). The independent factors associated with ICU admission were multi-organ dysfunction (OR 2.94 , 95% CI (1.35 to 6.42), p= 0.006) and bacteremia( OR 3.55, 95% CI (1.02 to 12.35), p=0.05) . The severity of neutropenia did not influence the predictability of ICU admission. 52.2%(n=12) of the mechanically ventilated patients expired. 10 of the patients on NIMV were reverted to palliative care and expired, the ICU mortality being 46.8%(n=22/47). The overall mortality was 19.8%.(n=22/111). Conclusion: Pneumonia in neutropenic patients with hematological pathology carries a high risk of ICU admission and significant mortality .