Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study.
Acute myeloid leukemia
Acute respiratory failure
Cluster analysis
Hospital mortality
Intensive care unit
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
02 Sep 2023
02 Sep 2023
Historique:
received:
31
05
2023
accepted:
14
08
2023
medline:
4
9
2023
pubmed:
4
9
2023
entrez:
2
9
2023
Statut:
epublish
Résumé
Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed. This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis. Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality. Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.
Sections du résumé
BACKGROUND
BACKGROUND
Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed.
METHODS
METHODS
This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis.
RESULTS
RESULTS
Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality.
CONCLUSIONS
CONCLUSIONS
Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.
Identifiants
pubmed: 37658994
doi: 10.1186/s13613-023-01172-3
pii: 10.1186/s13613-023-01172-3
pmc: PMC10474995
doi:
Types de publication
Journal Article
Langues
eng
Pagination
79Informations de copyright
© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).
Références
Leuk Lymphoma. 2018 Oct;59(10):2369-2376
pubmed: 29431568
Blood. 2022 Sep 22;140(12):1345-1377
pubmed: 35797463
Am J Respir Crit Care Med. 2003 May 15;167(10):1329-33
pubmed: 12574074
Cancer. 2021 Jun 15;127(12):2049-2061
pubmed: 33818756
Intensive Care Med. 2019 Jul;45(7):977-987
pubmed: 31143998
Clin Infect Dis. 2011 Feb 15;52(4):427-31
pubmed: 21205990
Blood. 2015 May 21;125(21):3246-52
pubmed: 25778528
Cancers (Basel). 2020 Jun 24;12(6):
pubmed: 32599837
Leuk Lymphoma. 2013 Aug;54(8):1724-9
pubmed: 23185988
Medicine (Baltimore). 2004 Nov;83(6):360-370
pubmed: 15525848
Leuk Res. 2023 Sep;132:107352
pubmed: 37423072
Leuk Lymphoma. 2018 Jun;59(6):1323-1331
pubmed: 28901791
Leukemia. 2014 Feb;28(2):289-92
pubmed: 23760400
Intensive Care Med. 2017 Dec;43(12):1808-1819
pubmed: 28948369
Blood Rev. 2015 Nov;29(6):359-67
pubmed: 25998991
PLoS One. 2022 Jun 29;17(6):e0270138
pubmed: 35767521
Leuk Lymphoma. 2014 Nov;55(11):2556-63
pubmed: 24475788
Haematologica. 2011 Feb;96(2):231-7
pubmed: 21071501
Blood. 2015 Jun 11;125(24):3789-97
pubmed: 25918347
BMC Cancer. 2010 Sep 28;10:516
pubmed: 20920175
CA Cancer J Clin. 2019 Sep;69(5):363-385
pubmed: 31184787
Am J Respir Crit Care Med. 2021 Jul 15;204(2):187-196
pubmed: 33751920
Lancet Respir Med. 2014 Aug;2(8):611-20
pubmed: 24853585
Ann Hematol. 2023 Apr;102(4):761-768
pubmed: 36773040
Lancet Respir Med. 2019 Feb;7(2):173-186
pubmed: 30529232
Anaesthesia. 2016 Sep;71(9):1081-90
pubmed: 27418297
Br J Haematol. 2005 May;129(3):350-7
pubmed: 15842658
Leuk Lymphoma. 2014 Jan;55(1):97-104
pubmed: 23597137
PLoS One. 2014 Jun 11;9(2):e98819
pubmed: 24919177
Hematology Am Soc Hematol Educ Program. 2015;2015:215-9
pubmed: 26637724
J Crit Care. 2004 Mar;19(1):29-35
pubmed: 15101003