Scripties UMCG - Rijksuniversiteit Groningen
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Long Term Outcome of Patients with a Haematological Malignancy Admitted at the Intensive Care Unit :Time Trend Analysis and the Influence of Multi-Organ Failure on Survival : A multi-centre retrospective observational cohort study

(2017) Vires, V.A. de (Vera)

Purpose. Patients with a haematological malignancy used to have one of the highest mortality rates of all cancer patients admitted to the Intensive Care Unit (ICU). Therefore physicians are reluctant to admit these patients to the ICU. However, recent studies suggest that at least short-term outcome is improving. The aim of our study was to provide evidence of improved long-term outcome and if this is caused by an even more restricted admission policy. Another aim was to clarify survival chances of patients with a haematological malignancy and multi-organ failure (MOF) admitted to the ICU. Further, we evaluated the predictive value of the APACHE II score.
Methods. A retrospective cohort study was performed in 5 Dutch university hospitals. We dichotomized the study period and studied prevalence of patient’s characteristics between these two equal periods. By using annual odds ratios, reflecting annual changes in mortality, we analysed which baseline characteristics could have had influenced possible trends in time. Organ failure was divided in acute kidney injury, respiratory failure, hepatic failure and haemodynamic failure. MOF was defined as the failure of ≥2 organs. Primary outcome was 1-year survival/mortality. WHO performance score was used to measure functional outcome. Approximated mortality rate, based on the APACHE II score, was compared with the actual ICU mortality rate, to study the predictive value of the APACHE II score.
Results. A total of 1095 patients were included from 2003-2015. The results of our study showed that the mortality of patients with a haematological malignancy admitted at the ICU has decreased over time and this could not be explained by an admission policy of patients with a lower APACHE II score. The data suggest that MOF should not be an exclusion criteria for ICU admission. Finally, the APACHE II score overestimates mortality in this patient category.

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