Patient selection: hematologic malignancy and admission to ICU
Outcomes: survival in ICU and survival after discharge. Observed ICU mortality rate was 44%.
Parameters:
(1) need for mechanical ventilation (respiratory failure)
(2) need for renal replacement therapy (renal failure)
(3) SAPS II score
(4) admission C-reactive protein (CRP) concentration in mg/L
Mortality for a patient requiring mechanical ventilation was high in the ICU and afterwards, with a 24 month survival of 5%. A patient who required neither mechanical ventilation nor renal replacement therapy had a 6 month survival of 50% and 24-month survival of 28%.
A CRP > 150 mg/L was associated with increased ICU mortality but did not predict subsequent mortality.
A SAPII score > 50 at ICU admission was associated with increased ICU mortality. 24 month survival was 8% vs 22% if SAPS II was <= 50.
|
SAPS II
|
ICU Mortality
|
|
< 40
|
22%
|
|
40 to 59
|
36%
|
|
60 to 79
|
70%
|
|
>= 80
|
78%
|
from Figure 2
Reasons for better survival of hematologic patients in the ICU:
(1) preadmission triage
(2) antimicrobial prophylaxis
(3) use of hematologic growth factors
(4) changes in respiratory support including use of noninvasive ventilation
(5) improved management of other organ failures
Improved ICU survival may not translate to better long-term survival.
