OUTCOME AND PROGNOSTIC FACTORS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY ADMITTED TO AN INTENSIVE CARE UNIT: A SINGLE-CENTER STUDY
Öz
Objective: This study aimed to determine if the prognostic factors associated with intensive care unit (ICU) outcomes in patients with hematological malignancy help determine the course of treatment.
Materials and Method: In this study, 107 adult patients with hematological malignancies, requiring ICU admission in 2014–2020 at Medipol University Hospital, were retrospectively screened. The collected data included: demographic characteristics, sepsis-related organ failure assessment (SOFA) score, and the use of noninvasive/invasive mechanical ventilation during the ICU stay. The prognostic factors of the patients that received blood transfusions and those that did not receive blood transfusions as part of their treatment were compared.
Results: Among the 107 patients with hematological malignancy that were admitted to the ICU, 67 (62.6%) were men. Of the patients admitted to the ICU, 39.3% had acute myeloid leukemia. The non-survivor rate was significantly higher in patients with a SOFA score>=2 (87.7%) and those that were intubated (98.7%) (p<0.05). The Acute Physiology and Chronic Health Evaluation (APACHE) score and creatinine levels were significantly higher in the non-survivor group (p<0.05). The pH values and base deficit values were significantly lower in the non-survivor group (p<0.05). The mean hemoglobin values on the first day of admittance to the ICU were 8.57±1.68 (4.9-13.6) and during the ICU stay average of 3 units were transfused. The C-reactive protein (CRP) levels and length of ICU stay (days) were significantly higher in the patients that received blood transfusions (p<0.05). The non-survivor rate (87.7%) was significantly higher in the patients with a SOFA score of (p<0.05).
Conclusion: If the prognostic factors of ICU outcomes in patients with a hematological disease are known, they can be used to help determine if mechanical ventilation, renal replacement, or blood transfusions are appropriate for patients with multiorgan failure. This multidisciplinary approach helps provide optimal treatment.
Anahtar Kelimeler
Kaynakça
- 1. 1. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task force of the American college of critical care medicine, Society of critical care medicine. Crit Care Med. 1999; 27(3): 639-660.
- 2. Mokart D, Etienne A, Essterni B, et al. Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand. 2012; 56: 178-189.
- 3. Carson JL, Stanworth SJ, Roubinian N, et al. Transfusion threshold and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Sys Rev. 2012; 18(4): CD002042.
- 4. River EP, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Eng J Med. 2001; 345(19): 1368-1377.
- 5. Vincent JL. Indication for blood transfusions: Too complex to base on a single number? Ann Intern Med. 2010; 157: 71-72.
- 6. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368: 11-21.
- 7. Dellinger RP, Levy MM, Rhodes A. Surviving sepsis campaign international guidelines for management of severe sepsis and septic shock 2012. Crit Care Med. 2013; 41(2): 580-637.
- 8. Benoit DD, Vandewoude KH, Decruyenaere JM, et al. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med. 2003; 31: 104-112.
- 9. Medic MG, Gornik I, V Gasparovic. Hematologic malignancies in the medical intensive care unit: Outcomes and prognostic factors. Hematology. 2015; 20(5): 247-253.
- 10. Ferra CH, Marcos P, Misis M, et al. Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: A single-center experience. Int J Hematol. 2007; 85: 195-202.
- 11. Staudinger T, Stoiser B, Müllner M, et al. Dotcom and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med. 2000; 28(5): 1322-1328.
- 12. Maqsood SH, Badar F, Hameed A. Characteristic and outcomes of patients with hematological malignancies admitted for intensive care- a single centre experience. Asian Pac J Cancer Prev. 2017; 18(7): 1833-1837.
- 13. Demandt AMP, Geerse DA, Janseen BJP, et al. The prognostic value of trend in modified SOFA score for patients with hematological malignancies in the intensive care unit. Eur J Haematol. 2017; 99: 315-322.
- 14. Yeo CHD, Kim JW, Kim SCH, et al. Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit Care. 2012; 27: 739-745.
- 15. Faquin WC, Scheneider TJ, Goldberg MA. Effect of inflammatory cytokines on hypoxia induced erythropoetin production blood. Blood. 1992; 79(8): 1887-1894.
- 16. Hebert PC, Wells G, Blajman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med. 1999; 340(6): 409-417.
- 17. Park DW, Chun B-B, Kwon S-S, et al. Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis. Crit Care Med. 2012; 40(12): 3140-3145.
- 18. Mark DG, Morehouse JW, Hung Y-Y, et al. In- hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: retrospective propensity-adjusted analysis. Crit Care. 2014; 18(5): 496-509.
- 19. Walsh TS, McArdle F, McLellan SA, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med. 2004; 32: 364-371.
YOĞUN BAKIM ÜNITESINE KABUL EDILEN HEMATOLOJIK MALIGNITELI HASTALARIN SONUÇLARI VE PROGNOSTIK FAKTÖRLERI: TEK MERKEZLI ÇALIŞMA
Öz
Amaç: Bu çalışmada, tedavileri esnasında yoğun bakım ünitesine (YBÜ) yatırılması gereken hematolojik maligniteli hastalarla ilgili prognostik faktörlerin, tedavi sürecini belirlemeye yardımcı olup olmadığını belirlemeyi amaçladık.
Gereç ve Yöntem: Bu çalışmada, Medipol Üniversite Hastanesi'nde 2014-2020 yılları arasında YBÜ'ye yatırılması gereken hematolojik maligniteli 107 erişkin hasta retrospektif olarak tarandı. Toplanan veriler şunları içeriyordu: demografik özellikler, hematolojik malignite türü, sepsisle ilişkili organ yetmezliği değerlendirme (SOFA) skoru ve YBÜ'de kalış sırasında noninvaziv/invaziv mekanik ventilasyon kullanımı. Kan transfüzyonu alan ve tedavisinin bir parçası olarak kan transfüzyonu almayan hastaların prognostik faktörleri ve sonuçları karşılaştırıldı.
Bulgular: Yoğun bakım ünitesine başvuran 107 hematolojik maligniteli hastanın 67'si (%62.6) erkekti. Yoğun bakım ünitesine kabul edilen hastaların %39.3'ünde akut miyeloid lösemi ve %60.7' sinde solunum yetmezliği vardı. SOFA skoru>=2 olanlarda (% 87.7) ve entübe edilenlerde (%98.7) hayatta kalmayan oranı anlamlı olarak yüksekti (p<0.05). Hayatta kalmayan grupta Acute Physiology and Chronic Health Evaluation (APACHE) skoru ve kreatinin düzeyleri anlamlı olarak yüksekti (p<0.05). Hayatta kalmayan grupta pH değerleri ve baz açığı değerleri anlamlı olarak düşüktü (p<0.05). YBÜ' ye kabulün ilk gününde ortalama hemoglobin değerleri 8.57±1.68 (4.9-13.6) idi ve YBÜ'de kalış süresi boyunca ortalama 3 ünite transfüze edildi. Kan transfüzyonu yapılan hastalarda C-reaktif protein (CRP) düzeyleri ve YBÜ' de kalış süresi (gün) anlamlı olarak yüksekti (p<0.05). SOFA skoru (p<0.05) olan hastalarda hayatta kalmayan oranı (%87.7) anlamlı olarak daha yüksekti.
Sonuç: Hematolojik hastalığı olan hastalarda mekanik ventilasyon uygulanması, renal replasman tedavisi veya kan transfüzyonlarının yoğun bakım yatış sürecini arttığı ve mortalite için risk faktörü olduğu unutulmamalıdır. Bu hastalara uygulanacak multidisipliner yaklaşım, optimum tedavinin sağlanmasına yardımcı olur.
Anahtar Kelimeler
Kaynakça
- 1. 1. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task force of the American college of critical care medicine, Society of critical care medicine. Crit Care Med. 1999; 27(3): 639-660.
- 2. Mokart D, Etienne A, Essterni B, et al. Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand. 2012; 56: 178-189.
- 3. Carson JL, Stanworth SJ, Roubinian N, et al. Transfusion threshold and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Sys Rev. 2012; 18(4): CD002042.
- 4. River EP, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Eng J Med. 2001; 345(19): 1368-1377.
- 5. Vincent JL. Indication for blood transfusions: Too complex to base on a single number? Ann Intern Med. 2010; 157: 71-72.
- 6. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368: 11-21.
- 7. Dellinger RP, Levy MM, Rhodes A. Surviving sepsis campaign international guidelines for management of severe sepsis and septic shock 2012. Crit Care Med. 2013; 41(2): 580-637.
- 8. Benoit DD, Vandewoude KH, Decruyenaere JM, et al. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med. 2003; 31: 104-112.
- 9. Medic MG, Gornik I, V Gasparovic. Hematologic malignancies in the medical intensive care unit: Outcomes and prognostic factors. Hematology. 2015; 20(5): 247-253.
- 10. Ferra CH, Marcos P, Misis M, et al. Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: A single-center experience. Int J Hematol. 2007; 85: 195-202.
- 11. Staudinger T, Stoiser B, Müllner M, et al. Dotcom and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med. 2000; 28(5): 1322-1328.
- 12. Maqsood SH, Badar F, Hameed A. Characteristic and outcomes of patients with hematological malignancies admitted for intensive care- a single centre experience. Asian Pac J Cancer Prev. 2017; 18(7): 1833-1837.
- 13. Demandt AMP, Geerse DA, Janseen BJP, et al. The prognostic value of trend in modified SOFA score for patients with hematological malignancies in the intensive care unit. Eur J Haematol. 2017; 99: 315-322.
- 14. Yeo CHD, Kim JW, Kim SCH, et al. Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit Care. 2012; 27: 739-745.
- 15. Faquin WC, Scheneider TJ, Goldberg MA. Effect of inflammatory cytokines on hypoxia induced erythropoetin production blood. Blood. 1992; 79(8): 1887-1894.
- 16. Hebert PC, Wells G, Blajman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med. 1999; 340(6): 409-417.
- 17. Park DW, Chun B-B, Kwon S-S, et al. Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis. Crit Care Med. 2012; 40(12): 3140-3145.
- 18. Mark DG, Morehouse JW, Hung Y-Y, et al. In- hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: retrospective propensity-adjusted analysis. Crit Care. 2014; 18(5): 496-509.
- 19. Walsh TS, McArdle F, McLellan SA, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med. 2004; 32: 364-371.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 27 Ekim 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 1 Sayı: 2 |
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