Dr Dorothy Liu, ICU, Princess Margaret Hospital
Objectives:
The aim of this study is to assess the mortality of patients with hematological malignancy admitted to the Intensive Care Unit of the Princess Margaret Hospital, and to determine the prognostic indictors in this population.
Patients and methods:
The records of 58 patients with hematologic malignancy admitted to the Intensive Care Unit between January 2005 and March 2009 were reviewed retrospectively. Variables at admission and during admission were collected, and evaluated for prognostic relevance by univariate and multivariate analyses.
Main results:
Overall hospital mortality was 69%. Survivors had a lower median Acute Physiology and Chronic Health Evaluation II score compared with the non-survivors (23.5 and 28.5 respectively; p=0.013). The median Simplified Acute Physiology Scale score was also lower in the survivors (43.5 vs. 61; P = 0.001), and likewise the median Sequential Organ Failure Assessment score ( 8 vs. 11 ; p = 0.001).
Multivariate analysis revealed mechanical ventilation (odds ratio 22.829, p = 0.001) and histological grading (odds ratio 8.088, p = 0.019) as significant prognostic factors of hospital mortality. Utilizing these two predictors as building blocks for further analysis, the subgroup of patients with a combination of the two factors, i.e. high grade and ventilated, were identified to have a particularly poor prognosis compared with the other subgroups made out of different combinations ( p = 0.001).
Conclusions:
The hospital mortality rates of patients with hematological malignancy admitted to the Intensive Care Unit was high. Necessity of mechanical ventilation and high histological grading were factors associated with mortality. These prognostic indicators enable physicians to be better equipped while counseling patients and their families with regards to realistic estimates of prognosis, and informed choices regarding treatment limitations should the situation requires.