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Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies

Dominique Vandijck (UGent) , Pieter Depuydt (UGent) , Fritz Offner (UGent) , JOKE NOLLET (UGent) , Renaat Peleman (UGent) , EVA STEEL (UGent) , Lucien Noens (UGent) , Johan Decruyenaere (UGent) and Dominique Benoit (UGent)
(2010) INTENSIVE CARE MEDICINE. 36(10). p.1744-1750
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Abstract
To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality. Retrospective analysis of prospectively collected data was performed. Sequential Organ Failure Assessment (SOFA) scores from day 1 to 5 were calculated in all consecutive hematologic malignancy patients admitted to the ICU (2000-2006). Patients were categorized according to the presence or absence, the diagnostic certainty, and the site of BI. Of the 344 patients admitted, 258 were still in the ICU at day 3 and 164 at day 5. Patients admitted because of BI had more severe OD on day 1 (SOFA 9.7 +/- A 4.0 vs. 8.4 +/- A 4.0, p = 0.008) but a more rapidly reversible OD within the first 3 days (Delta SOFA -1.12 +/- A 3.10 vs. 0.03 +/- A 3.40, p = 0.013) and a lower in-hospital (43.2% vs. 62.9%, p < 0.001) and 6-month mortality (52.1% vs. 71.7%, p < 0.001) than patients with other complications. In a multivariate analysis, BI remained associated with a lower risk of death (OR 0.20, 95% CI 0.1-0.4, p < 0.001) even after adjustment for the SOFA on day 1 (OR 1.36, 95% CI 1.22-1.52, p < 0.001) and the Delta SOFA (OR 1.48, 95% CI 1.29-1.68, p < 0.001). These findings remained significant regardless of the site and the diagnostic certainty of BI. BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other complications in ICU patients with hematologic malignancies. These findings further support the recommendation that these patients should certainly benefit from advanced life support, and in the case of an uncertain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial.
Keywords
ILL PATIENTS, ADMISSION, SEVERE SEPSIS, PROGNOSTIC-FACTORS, RESPIRATORY-FAILURE, CANCER-PATIENTS, SEPTIC SHOCK PATIENTS, RECENT INTRAVENOUS CHEMOTHERAPY, INTENSIVE-CARE-UNIT, Sequential Organ Failure Assessment score, Outcome, Hematologic malignancy, Evolution, Admission diagnosis, Critically ill, MULTICENTER

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Chicago
Vandijck, Dominique, Pieter Depuydt, Fritz Offner, JOKE NOLLET, Renaat Peleman, EVA STEEL, Lucien Noens, Johan Decruyenaere, and Dominique Benoit. 2010. “Impact of Organ Dysfunction on Mortality in ICU Patients with Hematologic Malignancies.” Intensive Care Medicine 36 (10): 1744–1750.
APA
Vandijck, D., Depuydt, P., Offner, F., NOLLET, J., Peleman, R., STEEL, E., Noens, L., et al. (2010). Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. INTENSIVE CARE MEDICINE, 36(10), 1744–1750.
Vancouver
1.
Vandijck D, Depuydt P, Offner F, NOLLET J, Peleman R, STEEL E, et al. Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. INTENSIVE CARE MEDICINE. 2010;36(10):1744–50.
MLA
Vandijck, Dominique, Pieter Depuydt, Fritz Offner, et al. “Impact of Organ Dysfunction on Mortality in ICU Patients with Hematologic Malignancies.” INTENSIVE CARE MEDICINE 36.10 (2010): 1744–1750. Print.
@article{1193509,
  abstract     = {To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality.
Retrospective analysis of prospectively collected data was performed. Sequential Organ Failure Assessment (SOFA) scores from day 1 to 5 were calculated in all consecutive hematologic malignancy patients admitted to the ICU (2000-2006). Patients were categorized according to the presence or absence, the diagnostic certainty, and the site of BI.
Of the 344 patients admitted, 258 were still in the ICU at day 3 and 164 at day 5. Patients admitted because of BI had more severe OD on day 1 (SOFA 9.7 +/- A 4.0 vs. 8.4 +/- A 4.0, p = 0.008) but a more rapidly reversible OD within the first 3 days (Delta SOFA -1.12 +/- A 3.10 vs. 0.03 +/- A 3.40, p = 0.013) and a lower in-hospital (43.2\% vs. 62.9\%, p {\textlangle} 0.001) and 6-month mortality (52.1\% vs. 71.7\%, p {\textlangle} 0.001) than patients with other complications. In a multivariate analysis, BI remained associated with a lower risk of death (OR 0.20, 95\% CI 0.1-0.4, p {\textlangle} 0.001) even after adjustment for the SOFA on day 1 (OR 1.36, 95\% CI 1.22-1.52, p {\textlangle} 0.001) and the Delta SOFA (OR 1.48, 95\% CI 1.29-1.68, p {\textlangle} 0.001). These findings remained significant regardless of the site and the diagnostic certainty of BI.
BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other complications in ICU patients with hematologic malignancies. These findings further support the recommendation that these patients should certainly benefit from advanced life support, and in the case of an uncertain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial.},
  author       = {Vandijck, Dominique and Depuydt, Pieter and Offner, Fritz and NOLLET, JOKE and Peleman, Renaat and STEEL, EVA and Noens, Lucien and Decruyenaere, Johan and Benoit, Dominique},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keyword      = {ILL PATIENTS,ADMISSION,SEVERE SEPSIS,PROGNOSTIC-FACTORS,RESPIRATORY-FAILURE,CANCER-PATIENTS,SEPTIC SHOCK PATIENTS,RECENT INTRAVENOUS CHEMOTHERAPY,INTENSIVE-CARE-UNIT,Sequential Organ Failure Assessment score,Outcome,Hematologic malignancy,Evolution,Admission diagnosis,Critically ill,MULTICENTER},
  language     = {eng},
  number       = {10},
  pages        = {1744--1750},
  title        = {Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies},
  url          = {http://dx.doi.org/10.1007/s00134-010-1903-8},
  volume       = {36},
  year         = {2010},
}

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