Admission factors predict mortality for blood cancers

ICU room

Patients with hematologic malignancies who are admitted to the intensive care unit (ICU) hold clues in their recent medical histories about their chances of survival.

Peter Hampshire, MD, of Glan Clwyd Hospital in Wales, and colleagues analyzed data from the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database from 178 adult, general ICUs in England, Wales, and Northern Ireland. Patients were admitted between December 1995 and March 2007.

Researchers also evaluated the performance of 3 severity-of-illness scores related to the population: The Acute Physiological and Chronic Health Evaluation (APACHE ) II, Simplified Acute Physiology Score (SAPS) II, and ICNARC.

APACHE II predicted hospital mortality most accurately. Mortality was underestimated by SAPS II and ICNARC.

Hematologic malignancies accounted for 7,689 (1.5%) patients admitted to the ICU. The team found that 26.4% were leukopenic, 54.3% had severe sepsis when admitted, 55% required ventilation within the first 24 hours in the ICU, and 61.7% were thrombocytopenic.

The median length of stay in the ICU was 2.3 days; 3,312 (43.1%) patients died in the ICU and 4,239 (59.2%) died during their stay in the hospital.

Nineteen factors were associated with increased hospital mortality. However, length of time the patient spent in the hospital prior to admittance to the ICU and patients with severe sepsis were strongly linked to increased hospital mortality.

The acute hospital mortality for patients admitted to the ICU immediately was 54.1%. The percentage increased to 70.8% for patients in the hospital 20 or more days before admittance to the ICU. These results suggest that such patients should be treated early and aggressively.

The hospital mortality increased as the number of organ failures upon admission increased. Patients with 4 organ failures had less than a 10% chance of survival, and hospital mortality reached 98.8% when patients with 5 organ failures were admitted to the ICU.

Low hematocrit was also linked to increased hospital mortality but requires further investigation.

The study was published online in Critical Care on August 24.