Outcome of patients with haematological malignancy admitted to the general ICU

Introduction

Previous studies have demonstrated a widely variable prognosis in critical illness amongst patients with haematological neoplastic disease; with inhospital mortality documented as high as 78% [1]. We sought to describe the outcomes in our population.

Methods

We conducted a retrospective study of consecutive admissions with a primary diagnosis of haematological malignancy over a 4-year period. Patients admitted recurrently as separate admissions were recorded as multiple events. Neutropenia was defined as <1.5 × 10⁹/l [2]. Outcome was defined as ICU mortality, inhospital mortality, length of ICU stay and requirement for mechanical ventilation or renal replacement therapy (RRT).

Results

Of 5,142 admissions, 33 had a primary diagnosis of haematological neoplasm (24 males). The average age was 55.8 ± 13.6 years. The median length of ICU stay was 5.4 days. The ICU mortality rate of all ICU admissions was 15.2%, compared with 39.4% in patients with haematological malignancy (P < 0.01). The inhospital mortality was 63.6%. Eleven patients were neutropenic on admission. In the neutropenic subgroup, ICU mortality was 45.5% (vs 36.3% in non-neutropenic patients, P = 0.46) and inhospital mortality was 45.5% (vs 72.7% in non-neutropenic patients). Of 22 patients requiring mechanical ventilation, the ICU mortality was 50% (vs 18.1%, P = 0.13) and inhospital mortality was 72.7% (vs 45%, P = 0.44). Of six patients requiring RRT, the ICU mortality was 50% (vs 37% in those patients not requiring RRT, P = 0.65) and inhospital mortality was 66.7% (vs 63%).

Conclusion

The mortality rate is high amongst patients in whom haematological malignancy is complicated by critical illness. Although significantly higher than our remaining ICU population, it was lower than reported elsewhere in the literature. Neutropenia on admission was not significantly associated with a poorer outcome. Although mortality was higher in those requiring mechanical ventilation or RRT, this did not reach statistical significance. This may be a result of our small sample size.