Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Critical Care

Bram Rochwerg¹  Laveena Munshi²  Sangeeta Mehta²  Peter M. Reardon³  Shannon M. Fernando³  Kwadwo Kyeremanteng³  Brent Herritt³  Andrew J. E. Seely³  Benjamin Gershkovich³  Daniel I. McIsaac⁴  Alexandre Tran⁴  Peter Tanuseputro⁴  Lana A. Castellucci⁴ 

[1] Department of Medicine, Division of Critical Care, McMaster University;Department of Medicine, Sinai Health System, and Interdepartmental Division of Critical Care Medicine, University of Toronto;Division of Critical Care, Department of Medicine, University of Ottawa;School of Epidemiology and Public Health, University of Ottawa;

关键词: Critical care;    Malignancy;    Mortality;    Chemotherapy;    Hematology;    Sepsis;   

DOI  :  10.1186/s13054-019-2568-5

来源: DOAJ

【 摘 要 】

Abstract Background Patients with hematologic malignancies who are admitted to hospital are at increased risk of deterioration and death. Rapid response systems (RRSs) respond to hospitalized patients who clinically deteriorate. We sought to describe the characteristics and outcomes of hematologic oncology inpatients requiring rapid response system (RRS) activation, and to determine the prognostic accuracy of the SIRS and qSOFA criteria for in-hospital mortality of hematologic oncology patients with suspected infection. Methods We used registry data from two hospitals within The Ottawa Hospital network, between 2012 and 2016. Consecutive hematologic oncology inpatients who experienced activation of the RRS were included in the study. Data was gathered at the time of RRS activation and assessment. The primary outcome was in-hospital mortality. Logistical regression was used to evaluate for predictors of in-hospital mortality. Results We included 401 patients during the study period. In-hospital mortality for all included patients was 41.9% (168 patients), and 145 patients (45%) were admitted to ICU following RRS activation. Among patients with suspected infection at the time of RRS activation, Systemic Inflammatory Response Syndrome (SIRS) criteria had a sensitivity of 86.9% (95% CI 80.9–91.6) and a specificity of 38.2% (95% CI 31.9–44.8) for predicting in-hospital mortality, while Quick Sequential Organ Failure Assessment (qSOFA) criteria had a sensitivity of 61.9% (95% CI 54.1–69.3) and a specificity of 91.4% (95% CI 87.1–94.7). Factors associated with increased in-hospital mortality included transfer to ICU after RRS activation (adjusted odds ratio [OR] 3.56, 95% CI 2.12–5.97) and a higher number of RRS activations (OR 2.45, 95% CI 1.63–3.69). Factors associated with improved survival included active malignancy treatment at the time of RRS activation (OR 0.54, 95% CI 0.34–0.86) and longer hospital length of stay (OR 0.78, 95% CI 0.70–0.87). Conclusions Hematologic oncology inpatients requiring RRS activation have high rates of subsequent ICU admission and mortality. ICU admission and higher number of RRS activations are associated with increased risk of death, while active cancer treatment and longer hospital stay are associated with lower risk of mortality. Clinicians should consider these factors in risk-stratifying these patients during RRS assessment.

【 授权许可】

Unknown