Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study

BMC Cancer

Research Article

Amanda L Roze des Ordons¹  Imran Mirza²  Kris Chan³  Sean M Bagshaw⁴  Derek R Townsend⁴ 

[1] Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 8440-112ST NW, T6G2B7, Edmonton, Alberta, Canada;Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta Hospital, 8440-112ST NW, T6G2B7, Edmonton, Alberta, Canada;Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 8440-112ST NW, T6G2B7, Edmonton, Alberta, Canada;Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, 8440-112ST NW, T6G2B7, Edmonton, Alberta, Canada;

关键词: Intensive Care Unit;    Intensive Care Unit Admission;    Sequential Organ Failure Assessment Score;    Intensive Care Unit Survival;    Therapeutic Intervention Scoring System;   

DOI  :  10.1186/1471-2407-10-516

 received in 2010-03-09, accepted in 2010-09-28,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThere is limited epidemiologic data on patients with acute myelogenous (myeloid) leukemia (AML) requiring life-sustaining therapies in the intensive care unit (ICU). Our objectives were to describe the clinical characteristics and outcomes in critically ill AML patients.MethodsThis was a retrospective case-control study. Cases were defined as adult patients with a primary diagnosis of AML admitted to ICU at the University of Alberta Hospital between January 1st 2002 and June 30th 2008. Each case was matched by age, sex, and illness severity (ICU only) to two control groups: hospitalized AML controls, and non-AML ICU controls. Data were extracted on demographics, course of hospitalization, and clinical outcomes.ResultsIn total, 45 AML patients with available data were admitted to ICU. Mean (SD) age was 54.8 (13.1) years and 28.9% were female. Primary diagnoses were sepsis (32.6%) and respiratory failure (37.3%). Mean (SD) APACHE II score was 30.3 (10.3), SOFA score 12.6 (4.0) with 62.2% receiving mechanical ventilation, 55.6% vasoactive therapy, and 26.7% renal replacement therapy. Crude in-hospital, 90-day and 1-year mortality was 44.4%, 51.1% and 71.1%, respectively. AML cases had significantly higher adjusted-hazards of death (HR 2.23; 95% CI, 1.38-3.60, p = 0.001) compared to both non-AML ICU controls (HR 1.69; 95% CI, 1.11-2.58, p = 0.02) and hospitalized AML controls (OR 1.0, reference variable). Factors associated with ICU mortality by univariate analysis included older age, AML subtype, higher baseline SOFA score, no change or an increase in early SOFA score, shock, vasoactive therapy and mechanical ventilation. Active chemotherapy in ICU was associated with lower mortality.ConclusionsAML patients may represent a minority of all critically ill admissions; however, are not uncommonly supported in ICU. These AML patients are characterized by high illness severity, multi-organ dysfunction, and high treatment intensity and have a higher risk of death when compared with matched hospitalized AML or non-AML ICU controls. The absence of early improvement in organ failure may be a useful predictor for mortality for AML patients admitted to ICU.

【 授权许可】

Unknown   
© Roze des Ordons et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.