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Survival and predictors of outcome in patients with acute leukemia admitted to the intensive care unit
Author(s) -
Thakkar Snehal G.,
Fu Alex Z.,
Sweetenham John W.,
Mciver Zachariah A.,
Mohan Sanjay R.,
Ramsingh Giridharan,
Advani Anjali S.,
Sobecks Ronald,
Rybicki Lisa,
Kalaycio Matt,
Sekeres Mikkael A.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23394
Subject(s) - medicine , acute leukemia , intensive care unit , univariate analysis , leukemia , retrospective cohort study , multivariate analysis , cancer , surgery
BACKGROUND. Predictors of outcome and rates of successful discharge have not been defined for patients with acute leukemia admitted to intensive care units (ICUs) in the US. METHODS. This is a retrospective analysis of 90 patients with acute leukemia (no history of bone marrow transplant) admitted to an ICU from 2001–2004. The primary endpoints were improvement and subsequent discharge from the ICU, discharge from the hospital, and 2‐month survival after hospital discharge. Secondary endpoints were 6‐ and 12‐month survival. Univariate and multivariate logistic regression analyses were performed to identify factors predicting outcome. RESULTS. The median age of patients was 54 years and 48 (53%) were male. The most common reason for ICU transfer for all patients was respiratory compromise. The majority of all patients (68%) were eventually placed on ventilator support and approximately half required pressors. During the ICU course, 29 patients (32%) improved and subsequently resumed aggressive leukemia management, and 24 patients (27%) survived to be discharged from the hospital. The 2‐, 6‐, and 12‐month overall survival was 24 (27%), 16 (18%), and 14 (16%), respectively. Higher APACHE II score, use of pressors, undergoing bone marrow transplantation preparative regimen, and adverse cytogenetics predicted worse outcome. Newly diagnosed leukemia, type of leukemia, or age did not. CONCLUSIONS. One of 4 patients with acute leukemia survived an ICU admission to be discharged from the hospital and were alive 2 months later. A diagnosis of acute leukemia should not disqualify patients from an ICU admission. Cancer 2008. © 2008 American Cancer Society.