Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study.

Hematologic malignancy Immunocompromised Long-term outcomes

Journal

Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851

Informations de publication

Date de publication:
11 Mar 2024
Historique:
received: 16 10 2023
accepted: 05 02 2024
medline: 11 3 2024
pubmed: 11 3 2024
entrez: 11 3 2024
Statut: aheadofprint

Résumé

Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described. We conducted a prospective, observational study of HM patients admitted to seven Canadian intensive care units (ICUs) (2018-2020). We followed survivors at 7 days, 6 months and 12 months following ICU discharge. The primary outcome was 12-month survival. We evaluated functional outcomes at 6 and 12 months using the functional independent measure (FIM) and short form (SF)-36 as well as variables associated with 12-month survival. We enrolled 414 patients including 35% women. The median age was 61 (interquartile range, IQR: 52-69), median Sequential Organ Failure Assessment (SOFA) score was 9 (IQR: 6-12), and 22% had moderate-severe frailty (clinical frailty scale [CFS] ≥ 6). 51% had acute leukemia, 38% lymphoma/multiple myeloma, and 40% had received a hematopoietic stem cell transplant (HCT). The most common reasons for ICU admission were acute respiratory failure (50%) and sepsis (40%). Overall, 203 (49%) were alive 7 days post-ICU discharge (ICU survivors). Twelve-month survival of the entire cohort was 21% (43% across ICU survivors). The proportion of survivors with moderate-severe frailty was 42% (at 7 days), 14% (6 months), and 8% (12 months). Median FIM at 7 days was 80 (IQR: 50-109). Physical function, pain, social function, mental health, and emotional well-being were below age- and sex-matched population scores at 6 and 12 months. Frailty, allogeneic HCT, kidney injury, and cardiac complications during ICU were associated with lower 12- month survival. 49% of all HM patients were alive at 7 days post-ICU discharge, and 21% at 12 months. Survival varied based upon hematologic diagnosis and frailty status. Survivors had important functional disability and impairment in emotional, physical, and general well-being.

Identifiants

DOI: 10.1007/s00134-024-07349-z PMID: 38466402
pubmed: 38466402
doi: 10.1007/s00134-024-07349-z
pii: 10.1007/s00134-024-07349-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Leukemia and Lymphoma Society of Canada
ID : 001

Informations de copyright

© 2024. Crown.

Références

Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R, Thyagu S, Munshi L (2021) Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 47(10):1104–1114
doi: 10.1007/s00134-021-06502-2 pubmed: 34519845
Azoulay E, Soares M, Lengilne E (2021) Preempting critical care services for patients with hematologic malignancies. Intensive Care Med 47(10):1140–1143
doi: 10.1007/s00134-021-06521-z pubmed: 34519846
Darmon M, Bourmaud A, Georges Q et al (2019) Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 45(7):977–987. https://doi.org/10.1007/s00134-019-05653-7
doi: 10.1007/s00134-019-05653-7 pubmed: 31143998
Scales D, Thiruchelvam D, Kiss A, Sibbald WJ, Redelmeier D (2008) Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis. Crit Care 12:R77
doi: 10.1186/cc6923 pubmed: 18547422 pmcid: 2481474
Azoulay É, Thiéry G, Chevret S et al (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine 83(6):360–370. https://doi.org/10.1097/01.md.0000145370.63676.fb
doi: 10.1097/01.md.0000145370.63676.fb pubmed: 15525848
Ehooman F, Biard L, Lemiale V et al (2019) Long-term health-related quality of life of critically ill patients with haematological malignancies: a prospective observational multicenter study. Ann Intensive Care 9:2. https://doi.org/10.1186/s13613-018-0478-3
doi: 10.1186/s13613-018-0478-3 pubmed: 30612249 pmcid: 6320707
Rabbat A, Chaoui D, Montani D et al (2005) Prognosis of patients with acute myeloid leukaemia admitted to intensive care. Br J Haematol 129:350–357. https://doi.org/10.1111/j.1365-2141.2005.05459.x
doi: 10.1111/j.1365-2141.2005.05459.x pubmed: 15842658
Schellongowski P, Staudinger T, Kundi M et al (2011) Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Haematologica 96:231–237. https://doi.org/10.3324/haematol.2010.031583
doi: 10.3324/haematol.2010.031583 pubmed: 21071501
Bernal T, Pardavila EV, Bonastre J et al (2013) Survival of hematological patients after discharge from the intensive care unit: a prospective observational study. Crit Care. https://doi.org/10.1186/cc13172
doi: 10.1186/cc13172 pubmed: 24377481 pmcid: 4056608
Herridge M, Program Investigators RECOVER et al (2016) The RECOVER program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Am J Respir Crit Care Med 194(7):831–844. https://doi.org/10.1164/rccm.201512-2343OC
doi: 10.1164/rccm.201512-2343OC pubmed: 26974173
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495
doi: 10.1503/cmaj.050051 pubmed: 16129869 pmcid: 1188185
Oczkowski WJ, Barreca S (1993) The functional independence measure: its use to identify rehabilitation needs in stroke survivors. Arch Phys Med Rehabil 74:1291–1294
doi: 10.1016/0003-9993(93)90081-K pubmed: 8259894
Ware JE Jr, Kosinski M, Gandek B (2005) SF-36 health survey manual & interpretation guide. Lincoln, Quality Metric
White IR, Poysteon P, Wood AM (2011) Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 30(4):377–399. https://doi.org/10.1002/sim.4067
doi: 10.1002/sim.4067 pubmed: 21225900
Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693
doi: 10.1056/NEJMoa022450 pubmed: 12594312
Asdahl PH, Christensen S, Kjaersgaard A, Christiansen CF, Kamper P (2020) One-year mortality among non-surgical patients with hematological malignancies admitted to the intensive care unit: a Danish nationwide population-based cohort study. Intensive Care Med 46:756–765
doi: 10.1007/s00134-019-05918-1 pubmed: 32072301
Azoulay E, Mokart PF et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—A Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique Study. J Clin Oncol 31(22):2810–2823
doi: 10.1200/JCO.2012.47.2365 pubmed: 23752112

Auteurs

Laveena Munshi (L)

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. Laveena.munshi@sinaihealth.ca.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Laveena.munshi@sinaihealth.ca.
ORCID: 0000-0003-0551-9533

Guillaume Dumas (G)

Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France.

Bram Rochwerg (B)

Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.

Farah Shoukat (F)

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.

Michael Detsky (M)

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.

Dean A Fergusson (DA)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Bruno L Ferreyro (BL)

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.

Paul Heffernan (P)

Department of Medicine at Queen's University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.

Margaret Herridge (M)

Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.

Sheldon Magder (S)

Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
Critical Care Department, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.

Mark Minden (M)

Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.

Rakesh Patel (R)

Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Department of Critical Care Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Salman Qureshi (S)

Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.

Aaron Schimmer (A)

Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.

Santhosh Thyagu (S)

Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.

Han Ting Wang (HT)

Division of Critical Care MedicineDepartment of Medicine at Hopital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.

Sangeeta Mehta (S)

Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.

Classifications MeSH