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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
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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
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
journal title
INTENSIVE CARE MEDICINE
Intensive Care Med.
volume
36
issue
10
pages
1744 - 1750
Web of Science type
Article
Web of Science id
000281950100016
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
4.996 (2010)
JCR rank
3/23 (2010)
JCR quartile
1 (2010)
ISSN
0342-4642
DOI
10.1007/s00134-010-1903-8
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1193509
handle
http://hdl.handle.net/1854/LU-1193509
date created
2011-03-22 09:40:20
date last changed
2015-06-17 09:30:50
@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},
}

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.