Abstract

Limited data exist on predictors of intensive care unit (ICU) admission in patients with hematologic malignancy. The objective of this study was to identify predictors of ICU admission in hospitalized patients with hematologic malignancies. A retrospective cohort study was conducted on 820 consecutive admissions of patients with a malignant hematology diagnosis at our institution between March 2009 and December 2015. Backward stepwise selection procedure was conducted for multivariable logistic regression analyses. 820 patients were included, of whom 179 (22%) were admitted to the ICU. Types of hematologic cancers included 71% (N = 578) lymphoid cancer, 18% (N = 151) myeloid cancer, and 10% (N = 80) plasma cell neoplasms. 14% (N = 111) of patients had acute leukemia. Six predictors of admission to ICU were found in multivariable analysis, including disease-related (acute leukemia, curative intent chemotherapy), laboratory-related (platelet count < 50 × 109/L, albumin below normal, LDH above normal at time of admission), and physician-related factors (having advanced directives discussion) (p < 0.0001). A significant proportion of patients with hematologic malignancies admitted to hospital are admitted to ICU. Utilizing the identified predictors of ICU admission may help guide timely informed goals of care discussions with patients before clinical deterioration occurs.

Highlights

  • Limited data exist on predictors of intensive care unit (ICU) admission in patients with hematologic malignancy

  • The prognosis of patients admitted to the intensive care unit (ICU) with hematologic malignancies remains guarded, with contemporary data showing up to 46%-90% mortality in the in-hospital s­ etting[1,2,3,4,5,6,7], which is significantly higher than the mortality of contemporaneous general medical patients admitted to the ­ICU7

  • ICU morbidity and mortality remain an important issue for patients with hematologic malignancy

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Summary

Introduction

Limited data exist on predictors of intensive care unit (ICU) admission in patients with hematologic malignancy. The objective of this study was to identify predictors of ICU admission in hospitalized patients with hematologic malignancies. Six predictors of admission to ICU were found in multivariable analysis, including disease-related (acute leukemia, curative intent chemotherapy), laboratory-related (platelet count < 50 × 109/L, albumin below normal, LDH above normal at time of admission), and physicianrelated factors (having advanced directives discussion) (p < 0.0001). Utilizing the identified predictors of ICU admission may help guide timely informed goals of care discussions with patients before clinical deterioration occurs. The primary objective of this study was to identify predictors of ICU admission in hospitalized patients with hematologic malignancies to enable more informed goals of care conversations with these patients on admission.

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