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Short‐ and long‐term outcomes of AL amyloidosis patients admitted into intensive care units
Author(s) -
Guinault Damien,
Canet Emmanuel,
Huart Antoine,
Jaccard Arnaud,
Ribes David,
Lavayssiere Laurence,
Venot Marion,
Cointault Olivier,
Roussel Murielle,
Nogier MarieBéatrice,
Pichereau Claire,
Lemiale Virginie,
Arnulf Bertrand,
Attal Michel,
Chauveau Dominique,
Azoulay Elie,
Faguer Stanislas
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14135
Subject(s) - medicine , al amyloidosis , amyloidosis , intensive care , proportional hazards model , retrospective cohort study , chemotherapy , intensive care unit , cohort , medical record , intensive care medicine , antibody , immunology , immunoglobulin light chain
Summary Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit‐related organ dysfunction or therapy‐related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units ( ICU s) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL ( n = 52) or AA ( n = 14) amyloidosis patients, with similar causes of admission to an ICU , the 28‐d and 6‐month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score ( IGS 2) was the only independent predictive factor for death by day 28, whereas the Mayo‐Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on‐going chemotherapy at ICU admission significantly predicted death at 6 months. Short‐term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on‐going chemotherapy for active amyloidosis impacted on long‐term outcomes.