Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies

Objective: To assess the outcome of intensive care unit (ICU) treatment in patients with hematological malignancies. Design and setting: Retrospective cohort study in the medical ICU of a university hospital. Patients: 104 critically ill patients after receiving conventional chemotherapy or autologous hematopoietic stem cell transplantation. Interventions: We analyzed demographic data, underlying disease, intensity of antineoplastic regimen, cause of admission, need for mechanical ventilation, and hemofiltration, ICU survival, and survival after discharge, furthermore neutrophil count, C-reactive protein (less than or equal to 150 vs. > 150 mg/l), antithrombin III, prothrombin time, and SAPS II (less than or equal to 50 vs. > 50) at ICU admission. All recorded variables were evaluated for prognostic relevance by univariate and multivariate analyses. Measurements and results: Overall ICU mortality was 44%, with significantly higher mortality in ventilated patients (74% vs. 12% in nonventilated patients, p < 0.001). Overall survival for the entire group 6 months and I year after ICU admission was 33% and 29%, respectively. Multivariate analysis revealed mechanical ventilation and SAPS II as independent prognostic factors of both ICU mortality and long-term survival, while C-reactive protein predicted only ICU mortality. Conclusions: The outcome of patients not requiring ventilatory support in this study was encouraging, while invasive ventilation was again confirmed as predicting a dismal prognosis in this population. Efforts should be directed to avoiding this procedure by reducing the pulmonary toxicity of antineoplastic treatment and to making ventilatory support more tolerable.