Outcome and Prognostic Factors of Patients with Hematological Malignancies Admitted to an Intensive Care Unit

Abstract Background Patients with hematological malignancies (HM) often develop complications due to their treatment or their underlying disease, requiring admission to an intensive care unit (ICU). Historically, it has been believed that the outcome of these patients were poor. However, there is emerging evidence showing improvements in ICU outcome for patients with HM, as well as for other patients with critical illness. This study aimed to study the outcomes and prognostic factors for patients with HM admitted to the ICU of a tertiary hospital in Asia. Methods We reviewed the case records of consecutive ICU admissions for patients under the hematology service in our institution, from July 2010 to June 2014. Patients who did not have a HM and those who were admitted for monitoring following an elective procedure were excluded. Clinical information was gathered, including details of their HM, co-morbidities, clinical status on admission to ICU, laboratory measurements, and treatment received in ICU. Sepsis-related Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. These were all evaluated for association with the primary outcome of survival to ICU discharge. Results A total of 288 admission episodes were reviewed, of which 264 were included for analysis. Of the excluded patients, 23 did not have a HM, and 1 was admitted following elective surgery. Overall ICU mortality was 34.8%, and overall hospital mortality was 45.8%. The mean duration of ICU stay was 5.3 days. The type of HM did not significantly affect the outcome (P = 0.87), nor did the presence of relapsed/refractory disease (P = 0.38). Neutropenia (< 1 x 109 /L) was associated with higher mortality (P = 0.02), as was the presence of a positive blood culture (P = 0.002). (Table 1) The use of red blood cell (P = 0.58) and platelet transfusions (P = 0.10) did not significantly affect the outcome. Patients who required the use of mechanical ventilation (P < 0.001) and vasopressor drugs (P < 0.001) did worse, but those who required the use of renal replacement therapy (P = 0.57) did not. Higher SOFA and APACHE II scores were both associated with higher rates of ICU mortality (both P < 0.001). Among the laboratory measurements on admission, platelet count, bilirubin, and aspartate aminotransferase (AST) were significantly different between survivors and non-survivors, while there were no significant differences in hemoglobin, white blood cell (WBC) count, sodium, potassium, urea, creatinine, and alanine aminotransferase (ALT) between the two groups. The 9 variables that were found to be significant with P < 0.05 were analyzed in a multivariable logistic regression model. APACHE II score (P < 0.001), use of mechanical ventilation (P = 0.003), use of vasopressor drugs (P < 0.001), and serum bilirubin (P = 0.004) were found to be independently associated with ICU mortality. Conclusion Patients with HM requiring ICU admission in our study had comparable survival to previous published studies. Physiological parameters and indicators of organ dysfunction at the point of ICU admission were predictors of ICU mortality. The type of HM and the presence of refractory disease did not have a significant effect on ICU outcome. This information can also help to determine which patients would benefit most from intensive care, which remains a costly and limited resource. The results also suggest that patients should not be denied ICU admission solely based on the status of their HM. Disclosures No relevant conflicts of interest to declare.

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Single Centre Experience of Patients with Haematological Malignancies Admitted to Intensive Care Unit: A Comparative Review of Allogenic Bone Marrow Transplant Data.

Blood ◽

10.1182/blood.v104.11.1830.1830 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1830-1830

Author(s):

Zi Yi Lim ◽

Jane Graham ◽

Sylvia Simpson ◽

Stephen Devereux ◽

Antonio Pagliuca ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Overall Survival ◽

Intensive Care ◽

Inotropic Support ◽

Haematological Malignancies ◽

Term Survival ◽

Icu Admission ◽

Icu Outcome ◽

Reduced Intensity

Abstract Introduction: Previous studies have indicated that the prognosis of patients with haematological malignancies who are admitted to intensive care unit (ICU) is poor. In particular, it has been suggested that the mortality for allogenic BMT patients requiring ICU admission is particularly high. The recent increased usage of reduced intensity conditioning has allowed allogenic transplantation of older patients who would previously be unsuitable for BMT. It is however unclear as to whether these patients may have a better ICU outcome. Methods: A retrospective review was performed of all haemato-oncology admissions to Kings College Hospital from May 2000 to Apr 2004 who were subsequently admitted to ICU. Information was collected from all patients for demographic factors, haematological status, APACHE score, organ dysfunction, microbiological data, and supportive organ therapy at point of admission to and during ICU stay. All variables were evaluated for prognostic relevance by univariate and multivariate analyses. Post-ICU survival was examined at day 30 and 1 year. Results: There were a total of 1249 admissions during the study period, of which 330(26.4%) were BMT patients. 57 ICU admissions (55 patients) were documented, 31 non-BMT (3.3%) vs 26 BMT (8.5%). The diagnoses were AML/MDS 26 (47.3%), ALL 6 (10.9%), NHL/HD 14 (25.5%), myeloma 5 (9.1%), others 4 (7.2%). Amongst post BMT patients, type of conditioning received was: reduced intensity 50%(13), standard myeloablative 34.6%(9), autologous 15.3%(4). 14 patients were early admissions within 6 months of BMT. The main cause of admission to ICU was due to chest sepsis with acute hypoxaemia. Conventional mechanical ventilation (MV) was used in 43(72.9%) of patients, and non-invasive MV in 16(27.1%). 30(50.8%) of patients received inotropic support during their ICU admission. Main cause of death was due to acute respiratory distress syndrome. There was no significant difference in age, duration of ICU admission and mechanical ventilation between non-BMT and BMT patients. However, the BMT group had higher numbers of myeloid malignancies, neutropenia, and intropic support. Overall ICU survival for the entire group, non-BMT, allogenic BMT (myeloablative + RIC) patients was 29.8%, 32.3% and 27.3% respectively. Kaplan-Meier estimation of longer term survival for these three groups at 30 day and 12 months was 23.7% and 14.6%, 20.1% and 10.9%, 24.3% and 19.5% respectively. The overall survival between these patient groups was not significant (p-value 0.757). Sub-analysis of RIC BMT data for 30 day and 1 year outcome was 35.8% and 29.3%, none of the 9 myeloablative patients survived beyond day 30. Univariate analysis identified intropic support, renal failure (creatinine >150), thrombocytopenia (platelet < 50) as significant variables for increased mortality (p-values 0.005, 0.012, 0.007 respectively). Results of multivariate analysis showed that inotropic support, was the only independant factor associated with increased ICU mortality. Estimated 30 day and 1 year survival for patients receiving vs not receiving inotropic support was 8% vs 39% and 6% vs 24%. Conclusion: Our data demonstrates that the admission of haemato-oncology patients to ICU can be associated with a favourable outcome. Significantly, in our cohort the overall survival of allogenic BMT patients was comparable with non-BMT patients. In addition, RIC patients appear to have a good ICU outcome and longer term survival.

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Predictors of Mortality in Patients Undergoing Autologous Stem Cell Transplant (ASCT) Admitted to the Intensive Care Unit: An Institutional Review of 1013 Transplant Patients over Five Years.

Blood ◽

10.1182/blood.v110.11.2876.2876 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2876-2876

Author(s):

Martina A. Trinkaus ◽

Stephen E. Lapinsky ◽

David C. Hallett ◽

Norman Franke ◽

Andrew Winter ◽

...

Keyword(s):

Intensive Care Unit ◽

Multiple Myeloma ◽

Mechanical Ventilation ◽

Intensive Care ◽

Febrile Neutropenia ◽

Organ Failure ◽

Admission Rate ◽

Apache Ii ◽

Gram Negative ◽

Icu Admission

Abstract Study Objective: To describe the outcomes of ASCT recipients transferred to the Intensive Care Unit (ICU), and identify predictors for mortality. Methods: Retrospective review of all ASCT recipients from Jan 2001-July 2006 who required ICU transfer up to 100 days post ASCT. Measurements and main Results: Thirty-four of 1013 patients (3.3%) who underwent ASCT, were admitted to the ICU. The mean age at admission was 54.9 +/− 11.1 (range 28–71), 53% being female. Indications for ASCT included multiple myeloma (50%), amyloidosis (32%), or other malignancies (18%). Table 1 highlights the admission rate to the ICU by diagnosis. The primary admitting diagnosis in the ICU included sepsis (32%), cardiac related events (26%), or respiratory compromise (29%). Median days post ASCT was 10.0 days with a median in ICU stay of 4.0 days (range 1–37 days). Twenty patients (including all non-survivors) required mechanical ventilation for > 24 hours with a median duration of 3.0 days. Thirteen patients died (38%) in the ICU, with 11 dying of multi-system organ failure and 2 from cardiac arrest. Retrospectively collected parameters restricted to the first 24 hours of admission revealed that Sequential Organ Failure Assessment (SOFA) score (OR 1.30; CI95 1.09–1.64, P=0.003) and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR 1.43; CI95 1.14–2.16; P=0.0002) were statistically associated with mortality in univariate analysis. The variables predictive of mortality at 24 hours after admission are displayed in Table 2. Conclusion: ICU admission is uncommon, occuring in 3% of patients undergoing ASCT, of which 38% die (1% of total ASCTs). Admission is influenced by underlying diagnosis, with amyloid patients portending the highest risk. Mortality in ASCT patients admitted to the ICU can be predicted in the first 24 hours by specific assessment scores (SOFA and APACHE II); specific supportive care requirements: inotropic dependence, hemodialysis, and need for ventilation; and clinical findings of gram negative sepsis or > 2 organ failure. Patients with febrile neutropenia had a low risk of mortality (possibly due to aggressive antibiotic use, growth factors, and rapid engraftment post ASCT). These results may assist clinical decision making regarding the continuation of intensive care delivered 24 hours after admission. Percentage Admission Rate by Diagnosis (n = 1013) Diagnosis ASCT (#) ICU Admission (#)/ (%) Non-survivors (#) Multiple Myeloma 615 17 / (2.8%) 6 Non-Hodgkin’s Lymphoma 199 2/ (1.0%) 1 Hodgkin’s Lymphoma 112 1 / (0.9%) 0 Amyloidosis 39 11/ (28.2%) 6 Acute Myeloid Leukemia 17 1/ (5.9%) 0 Other (Germ Cell Tumour, Waldenstrom’s Macroglobuliemia, POEMS) 31 2/ (6.4%) 0 Variables Predictive of Mortality at 24 hours after Admission Variable Predictors Number of Patients Survivors (n = 21) Non-survivors (n = 13) P-value Febrile Neutropenia 15 13 (62%) 2 (15%) 0.013 Failure of > 2 organs 20 9 (43%) 11 (85%) 0.030 Mechanical Ventilation 20 9 (43%) 11 (85%) 0.030 Inotropic Support > 4 hours 10 3 (14%) 7 (54%) 0.022 Hemodialysis 12 4 (19%) 8 (62%) 0.025 Gram Negative Infection 6 1 (5%) 5 (42%) 0.016

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Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit

Critical Care Research and Practice ◽

10.1155/2016/2610873 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Arthur Kwizera ◽

Mary Nabukenya ◽

Agaba Peter ◽

Lameck Semogerere ◽

Emmanuel Ayebale ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Low Income ◽

Clinical Characteristics ◽

Income Country ◽

Apache Ii ◽

Icu Mortality ◽

Hiv Patients ◽

Low Income Country

Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU.Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference toP<0.05.Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4,P=0.01)), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76,P=0.01)), and ARDS (OR 4.5 (95% CI: 1.07–16.7,P=0.04)) had a statistically significant association with mortality.Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.

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Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study

Metabolites ◽

10.3390/metabo10100386 ◽

2020 ◽

Vol 10 (10) ◽

pp. 386

Author(s):

Alice G. Vassiliou ◽

Edison Jahaj ◽

Ioannis Ilias ◽

Vassiliki Markaki ◽

Sotirios Malachias ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Lactate ◽

Organ Dysfunction ◽

Apache Ii ◽

Icu Mortality ◽

Icu Patients ◽

Time Pattern ◽

Cox Regression Analysis ◽

Icu Admission

Coronavirus disease-19 (COVID-19) continues to be a health threat worldwide. Increased blood lactate is common in intensive care unit (ICU) patients; however, its association with outcomes in ICU COVID-19 patients remains currently unexplored. In this retrospective, observational study we assessed whether lactate is associated with outcomes in COVID-19 patients. Blood lactate was measured on ICU admission and thereafter daily up to day 14 in 45 patients with confirmed COVID-19 pneumonia. Acute physiology and chronic health evaluation (APACHE II) was calculated on ICU admission, and sequential organ failure assessment (SOFA) score was assessed on admission and every second day. The cohort was divided into survivors and non-survivors based on 28-day ICU mortality (24.4%). Cox regression analysis revealed that maximum lactate on admission was independently related to 28-day ICU mortality with time in the presence of APACHE II (RR = 2.45, p = 0.008). Lactate’s area under the curve for detecting 28-day ICU mortality was 0.77 (p = 0.008). Mixed model analysis showed that mean daily lactate levels were higher in non-survivors (p < 0.0001); the model applied on SOFA scores showed a similar time pattern. Thus, initial blood lactate was an independent outcome predictor in COVID-19 ICU patients. The time course of lactate mirrors organ dysfunction and is associated with poor clinical outcomes.

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Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

Journal of Intensive Care Medicine ◽

10.1177/0885066618815804 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1104-1111 ◽

Cited By ~ 4

Author(s):

George L. Anesi ◽

Nicole B. Gabler ◽

Nikki L. Allorto ◽

Carel Cairns ◽

Gary E. Weissman ◽

...

Keyword(s):

South Africa ◽

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Primary Outcome ◽

Resource Limited Setting ◽

Icu Mortality ◽

Icu Admission ◽

Resource Limited ◽

Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

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Changes in muscle ultrasound for the diagnosis of intensive care unit acquired weakness in critically ill patients

Scientific Reports ◽

10.1038/s41598-021-97680-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Weiqing Zhang ◽

Jun Wu ◽

Qiuying Gu ◽

Yanting Gu ◽

Yujin Zhao ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Diagnostic Accuracy ◽

Biceps Brachii ◽

Rectus Femoris ◽

Apache Ii ◽

Cross Sectional ◽

Icu Admission ◽

The Right ◽

Muscle Ultrasound

AbstractTo test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.

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Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis

CNS Oncology ◽

10.2217/cns-2021-0009 ◽

2021 ◽

pp. CNS77

Author(s):

Jennifer H Kang ◽

Christa B Swisher ◽

Evan D Buckley ◽

James E Herndon ◽

Eric S Lipp ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Tumor ◽

Hematological Malignancies ◽

Descriptive Analysis ◽

Primary Brain Tumor ◽

Icu Mortality ◽

Tumor Patients ◽

Common Indication ◽

Better Than

Purpose: To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Methods: Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Results: Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care.

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Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research ◽

10.1177/0300060517744427 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1254-1262 ◽

Cited By ~ 3

Author(s):

Surat Tongyoo ◽

Tanuwong Viarasilpa ◽

Chairat Permpikul

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

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Outcome and Prognostic Factors in Patients with Hematological Malignancy That Are Admitted to the Intensive Care Unit.

Blood ◽

10.1182/blood.v104.11.5285.5285 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5285-5285

Author(s):

Christelle Ferra ◽

Maite Misis ◽

Albert Oriol ◽

Pilar Marcos ◽

Natalia Lloveras ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hematological Malignancies ◽

Hematological Malignancy ◽

Icu Admission ◽

Life Threatening ◽

Discharged Patients ◽

Life Threatening Complication

Abstract When patients with hematological malignancies develop a life-threatening complication there may be reluctance to admit them in intensive care units (ICU) because of their supposed poor prognosis. The objective of this study was to evaluate the mortality during the ICU admission, the long-term survival, and the prognostic factors that contribute to the survival of patients with hematological malignancies who were transferred to ICU due to a life-threatening complication. From January 2000 to May 2004, the variables at admission and during stay at the ICU, and the follow-up were reviwed in 58 consecutive critically-ill patients with a hematological malignancy from a single institution. The median age (range) was 55 (15–75) years and the male/female ratio was: 38/20. The hematological underlying diseases were: NHL (18 patients), AML (10), ALL (9), MM (6), chronic lymphoproliferative disorder (5), chronic myeloproliferative disorder (4), myelodysplastic syndrome (3), aplastic anemia (2) and Hodgkin’s lymphoma (1). Seven patients had received a hematopoietic stem cell transplant prior to the ICU admission. The main life-threatening acute illness precipitating the ICU transfer were: septic shock (26 patients, 45%), respiratory failure (21, 36%), non-septic hemodynamic instability (5, 9%), respiratory arrest related to a neurological event (2, 3%), post-surgical status (2, 3%), cardiac infarction (1, 2%) and polytrauma (1, 2%). Twenty-one patients (36%) could be discharged alive from the ICU. The median overall survival (range) for ICU discharged patients was 23 (0–54) months, with a median follow-up of 8 months. The actuarial probability of discharged patients to be alive was 56% (CI 95%: 31–75) at 6 months, and a 48% (CI 95%: 13–70) at 12 months. The mean Acute Physiology and Chronic Health Evaluation II (APACHE) score at admission, neutropenia, need for mechanical ventilation, maximum FIO2 requirements at 24 hours from admission, presence of septic shock, renal impairment or liver damage, were associated with a poor outcome in the univariate analysis. A documented infection was not associated with a higher mortality rate except for fungal infection. The APACHE II score at 48 and 72 hours of ICU admission decreased both in surviving and non-surviving patients due to therapeutic manoeuvres and was not predictive of the outcome. The type of the hematological malignancy, its prognosis and the presence of active disease at ICU admission did not predict patients outcome in our series. The number of failing organs also predicted a poorer survival for patients with more than two failing organs (p=0.038). In a multivariate logistical regression model, only the cardiovascular failure requiring vasoactive and the need of mechanical ventilation predicted outcome in the ICU admitted patients diagnosed with a hematological malignancy. A high proportion of admitted patients with a life-threatening complication and a hematological malignancy could be discharged from ICU. Although the mortality rate immediately after ICU discharge was high, those patients that survived the first week outside ICU had an expected survival only conditioned by their hematological malignancy.

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Super Obesity in the Medical Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066618761363 ◽

2018 ◽

Vol 35 (5) ◽

pp. 478-484

Author(s):

Santhi Iyer Kumar ◽

Kathleen Doo ◽

Julie Sottilo-Brammeier ◽

Christianne Lane ◽

Janice M. Liebler

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Obese Patients ◽

Super Obesity ◽

Super Obese ◽

Medical Intensive Care ◽

Reason For Admission

Background: Studies exploring the effect of body mass index (BMI) on outcomes in the intensive care unit (ICU) have yielded mixed results, with few studies assessing patients at the extremes of obesity. We sought to understand the clinical characteristics and outcomes of patients with super obesity (BMI > 50 kg/m2) as compared to morbid obesity (BMI > 40 kg/m2) and obesity (BMI > 30 kg/m2). Methods: A retrospective review of patients admitted to the Los Angeles County + University of Southern California medical intensive care unit (MICU) service between 2008 and 2013 was performed. The first 150 patients with BMI 30 to 40, 40 to 50, and 50+ were separated into groups. Demographic data, comorbid conditions, reason for admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, serum bicarbonate, and arterial carbon dioxide pressure (Pco 2) at admission were collected. Hospital and ICU length of stay (LOS), discharge disposition, mortality, use of mechanical ventilation (invasive and noninvasive), use of radiography, and other clinical outcomes were also recorded. Results: There was no difference in age, sex, and APACHE II score among the 3 groups. A pulmonary etiology was the most common reason for admission in the higher BMI categories ( P < .001). There was no difference in mortality among the groups. Intensive care unit and hospital LOS rose with increasing BMI ( P < .001). Patients admitted for pulmonary etiologies and higher BMIs had an increased ICU and hospital LOS ( P < .001). Super obese patients used significantly more noninvasive mechanical ventilation (NIMV, P < .001). There were no differences in the use of invasive mechanical ventilation across the groups. Conclusion: Super obese patients are most commonly admitted to the MICU with pulmonary diagnoses and have an increased use of noninvasive ventilation. Super obesity was not associated with increased ICU mortality. Clinicians should be prepared to offer NIMV to super obese patients and anticipate a longer LOS in this group.

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