Top

Intensive Care Medicine

Published in:

01-04-2020 | Care | Original

One-year mortality among non-surgical patients with hematological malignancies admitted to the intensive care unit: a Danish nationwide population-based cohort study

Authors: Peter H. Asdahl, Steffen Christensen, Anders Kjærsgaard, Christian F. Christiansen, Peter Kamper

Published in: Intensive Care Medicine | Issue 4/2020

Abstract

Purpose

Contemporary data on mortality of hematological patients admitted to the intensive care unit (ICU) are missing. In a Danish nationwide set-up, we assessed 30-day and 1-year mortality in this population including impact of age and comorbidity, with non-hematological patients as reference.

Methods

This population-based cohort study included all non-surgical patients > 15 years of age admitted to an ICU in Denmark between 2010 and 2015. Data on hematological malignancies were obtained from the Danish Hematological Database, and information on the Charlson Comorbidity Index was obtained from the Danish National Patient Registry. Thirty-day and 1-year mortality was estimated using the Kaplan–Meier method. We used Cox proportional hazards regression to estimate hazard ratios.

Results

We included 2122 ICU patients with a hematological malignancy and 88,951 non-hematological ICU patients. The 30-day mortality was 44% (95% confidence interval: 42–47%) among hematological patients and 27% (27–27%) among non-hematological patients. Similarly, 1-year mortality was 66% (64–68%) and 37% (37–37%), respectively. The corresponding hazard ratio with adjustment for age, sex, and comorbidity was 1.62 (1.54–1.71). Excess mortality was observed in all subgroups of age or of comorbidity. For example, the 1-year mortality for patients with Charlson Comorbidity Index Score > 3: 70% (66–74%) among hematological patients and 62% (61–63%) among non-hematological patients.

Conclusion

ICU patients with hematological malignancy had higher mortality than other ICU patients. However, one third of critically ill patients with a hematological malignancy is alive 1 year after ICU admission

Available only for authorised users

[1]

M Sant P Minicozzi M Mounier 2014 Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study Lancet Oncol 15 931 942 https://doi.org/10.1016/s1470-2045(14)70282-7 CrossRefPubMed

[2]

VA Vries MC Müller SM Arbous 2018 Time trend analysis of long term outcome of patients with haematological malignancies admitted at dutch intensive care units Br J Haematol 181 68 76 https://doi.org/10.1111/bjh.15140 CrossRefPubMed

[3]

M Hallek 2017 Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment Am J Hematol 92 946 965 https://doi.org/10.1002/ajh.24826 CrossRef

[4]

JL Warren LC Harlan J Stevens 2013 Multiple myeloma treatment transformed: a population-based study of changes in initial management approaches in the United States J Clin Oncol 31 1984 1989 https://doi.org/10.1200/jco.2012.46.3323 CrossRefPubMedPubMedCentral

[5]

R Rosa T Tonietto B Duso 2017 Mortality of adult critically ill subjects with cancer Respir Care 62 615 622 https://doi.org/10.4187/respcare.05210 CrossRefPubMed

[6]

D Mokart J Lambert D Schnell 2013 Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure Leuk Lymphoma 54 1724 1729 https://doi.org/10.3109/10428194.2012.753446 CrossRefPubMed

[7]

E Azoulay D Mokart F Pène 2013 Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium a groupe de recherche respiratoire en réanimation onco-hématologique study J Clin Oncol 31 2810 2818 https://doi.org/10.1200/jco.2012.47.2365 CrossRefPubMed

[8]

M Schmidt L Pedersen H Sørensen 2014 The Danish Civil Registration System as a tool in epidemiology Eur J Epidemiol 29 541 549 https://doi.org/10.1007/s10654-014-9930-3 CrossRefPubMed

[9]

C Christiansen M Møller H Nielsen S Christensen 2016 The Danish Intensive Care Database Clin Epidemiol 8 525 530 https://doi.org/10.2147/clep.s99476 CrossRefPubMedPubMedCentral

[10]

L Østgård J Nørgaard K Raaschou-Jensen 2016 The Danish National Acute Leukemia Registry Clin Epidemiol 8 553 560 https://doi.org/10.2147/clep.s99460 CrossRefPubMedPubMedCentral

[11]

B Arboe T El-Galaly M Clausen 2016 The Danish National Lymphoma Registry: coverage and data quality Plos One 11 e0157999 https://doi.org/10.1371/journal.pone.0157999 CrossRefPubMedPubMedCentral

[12]

P Gimsing MO Holmström T Klausen 2016 The Danish National Multiple Myeloma Registry Clin Epidemiol 8 583 587 https://doi.org/10.2147/clep.s99463 CrossRefPubMedPubMedCentral

[13]

M Bak E Ibfelt T Larsen 2016 The Danish National Chronic Myeloid Neoplasia Registry Clin Epidemiol 8 567 572 https://doi.org/10.2147/clep.s99462 CrossRefPubMedPubMedCentral

[14]

L Østgård J Nørgaard M Severinsen 2013 Data quality in the Danish National Acute Leukemia Registry: a hematological data resource Clin Epidemiology 5 335 344 https://doi.org/10.2147/clep.s48411 CrossRef

[15]

SK Thygesen CF Christiansen S Christensen 2011 The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients Bmc Med Res Methodol 11 83 https://doi.org/10.1186/1471-2288-8-25 CrossRefPubMedPubMedCentral

[16]

N Schenker JM Taylor 1996 Partially parametric techniques for multiple imputation Comput Stat Data Anal 22 425 446 https://doi.org/10.1016/0167-9473(95)00057-7 CrossRef

[17]

Rubin D (1987) Multiple Imputation for Nonresponse in Surveys.

[18]

IR White P Royston 2009 Imputing missing covariate values for the Cox model Stat Med 28 1982 1998 https://doi.org/10.1002/sim.3618 CrossRefPubMedPubMedCentral

[19]

J Ludvigsson M Nørgaard E Weiderpass 2015 Ethical aspects of registry-based research in the Nordic countries Clin Epidemiol 7 491 18 https://doi.org/10.2147/clep.s90589 CrossRefPubMedPubMedCentral

[20]

SA Ñamendys-Silva EP Plata-Menchaca E Rivero-Sigarroa A Herrera-Gómez 2015 Opening the doors of the intensive care unit to cancer patients: a current perspective World J Crit Care Med 4 159 162 https://doi.org/10.5492/wjccm.v4.i3.159 CrossRefPubMedPubMedCentral

[21]

H Wunsch DC Angus DA Harrison 2008 Variation in critical care services across North America and Western Europe and ast Crit Care Med 36 2787 e8 https://doi.org/10.1097/ccm.0b013e318186aec8 CrossRefPubMed

[22]

A Rhodes P Ferdinande H Flaatten 2012 The variability of critical care bed numbers in Europe Intens Care Med 38 1647 1653 https://doi.org/10.1007/s00134-012-2627-8 CrossRef

[23]

M Vliet van IW Verburg M Boogaard van den 2014 Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units Intens Care Med 40 1275 1284 https://doi.org/10.1007/s00134-014-3373-x CrossRef

[24]

PA Hampshire CA Welch LA McCrossan 2009 Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database Crit Care 13 R137 https://doi.org/10.1186/cc8016 CrossRefPubMedPubMedCentral

[25]

DD Benoit KH Vandewoude JM Decruyenaere 2003 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 31 104 112 https://doi.org/10.1097/00003246-200301000-00017 CrossRefPubMed

[26]

S Horster JH Stemmler PC Mandel 2012 Mortality of patients with hematological malignancy after admission to the intensive care unit Oncol Res Treat 35 556 561 https://doi.org/10.1159/000342672 CrossRef

[27]

E Beers van M Müller A Vlaar 2016 Haematological malignancy in the intensive care unit: microbiology results and mortality Eur J Haematol 97 271 277 https://doi.org/10.1111/ejh.12721 CrossRefPubMed

[28]

E Faucher M Cour V Jahandiez 2016 Short- and long-term outcomes in onco-hematological patients admitted to the intensive care unit with classic factors of poor prognosis Oncotarget 7 22427 22438CrossRef

[29]

J Liu Q Cheng Q Yang 2015 Prognosis-related factors in intensive care unit (ICU) patients with hematological malignancies: a retrospective cohort analysis in a Chinese population Hematology 20 494 503 https://doi.org/10.1179/1607845414y.0000000216 CrossRefPubMed

[30]

S Maqsood F Badar A Hameed 2017 Characteristics and outcomes of patients with hematological malignancies admitted for intensive care - a single centre experience Asian Pac J Cancer Prev Apjcp 18 1833 1837PubMed

[31]

SA Ñamendys-Silva MO González-Herrera FJ García-Guillén 2013 Outcome of critically ill patients with hematological malignancies Ann Hematol 92 699 705 https://doi.org/10.1007/s00277-013-1675-7 CrossRefPubMed

[32]

F Pène JI Salluh T Staudinger 2014 Has survival increased in cancer patients admitted to the ICU? No Intens Care Med 40 1573 1575 https://doi.org/10.1007/s00134-014-3412-7 CrossRef

[33]

DD Benoit M Soares E Azoulay 2014 Has survival increased in cancer patients admitted to the ICU? We are not sure Intens Care Med 40 1576 1579 https://doi.org/10.1007/s00134-014-3480-8 CrossRef

[34]

D Mokart SM Pastores M Darmon 2014 Has survival increased in cancer patients admitted to the ICU? Yes Intens Care Med 40 1570 1572 https://doi.org/10.1007/s00134-014-3433-2 CrossRef

[35]

M Kiehl G Beutel B Böll 2018 Consensus statement for cancer patients requiring intensive care support Ann Hematol 97 1271 1282 https://doi.org/10.1007/s00277-018-3312-y CrossRefPubMedPubMedCentral

[36]

E Azoulay F Pène M Darmon 2015 Managing critically Ill hematology patients: time to think differently Blood Rev 29 359 367 https://doi.org/10.1016/j.blre.2015.04.002 CrossRefPubMed

[37]

E Lengline E Raffoux V Lemiale 2012 Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure Leukemia Lymphoma 53 1352 1359 https://doi.org/10.3109/10428194.2011.649752 CrossRefPubMed

[38]

G Bird P Farquhar-Smith T Wigmore 2012 Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 year study Bja Br J Anaesth 108 452 459 https://doi.org/10.1093/bja/aer449 CrossRefPubMed

[39]

I Moors DD Benoit 2014 Time to look beyond one-year mortality in critically ill hematological patients? Crit Care 18 107 https://doi.org/10.1186/cc13722 CrossRefPubMedPubMedCentral

Title: One-year mortality among non-surgical patients with hematological malignancies admitted to the intensive care unit: a Danish nationwide population-based cohort study
Authors: Peter H. Asdahl
Steffen Christensen
Anders Kjærsgaard
Christian F. Christiansen
Peter Kamper
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Intensive Care Medicine / Issue 4/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05918-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

One-year mortality among non-surgical patients with hematological malignancies admitted to the intensive care unit: a Danish nationwide population-based cohort study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2020

Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline

Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study

Acute respiratory distress syndrome and cutaneous eruption in an immunocompetent adult

Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target

Heterogeneity of treatment effect of prophylactic pantoprazole in adult ICU patients: a post hoc analysis of the SUP-ICU trial

Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial