Survival of hematological patients after discharge from the intensive care unit: A prospective observational study

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Abstract

Introduction: Although the survival rates of hematological patients admitted to the ICU are improving, little is known about the long-term outcome. Our objective was to identify factors related to long-term outcome in hematological patients after ICU discharge.Methods: A prospective, observational study was carried out in seven centers in Spain. From an initial sample of 161 hematological patients admitted to one of the participating ICUs during the study period, 62 were discharged alive and followed for a median time of 23 (1 to 54) months. Univariate and multivariate analysis were performed to identify the factors related to long term-survival. Finally, variables that influence the continuation of the scheduled therapy for the hematological disease were studied.Results: Mortality after ICU discharge was 61%, with a median survival of 18 (1 to 54) months. In the multivariate analysis, an Eastern Cooperative Oncology Group score (ECOG) >2 at ICU discharge (Hazard ratio 11.15 (4.626 to 26.872)), relapse of the hematological disease (Hazard ratio 9.738 (3.804 to 24.93)) and discontinuation of the planned treatment for the hematological disease (Hazard ratio 4.349 (1.286 to 14.705)) were independently related to mortality. Absence of stem cell transplantation, high ECOG and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores decreased the probability of receiving the planned therapy for the hematological malignancy.Conclusions: Both ICU care and post-ICU management determine the long-term outcome of hematological patients who are discharged alive from the ICU. © 2013 Bernal et al.; licensee BioMed Central Ltd.

Figures

  • Figure 1 Patients included in the EMEHU study and subpopulation included in the present study.
  • Table 1 Characteristics of the study population
  • Figure 2 Overall survival of the whole population after ICU discharge (continuous black line) with 95% confidence intervals (dotted gray lines).
  • Table 2 Results of the univariate analysis studying the differences in variables collected before ICU discharge between long-term survivors and non-survivors
  • Figure 3 Survival curves. Estimated survival curves according to the Cox Cooperative Oncology Group (ECOG) score (B) and each therapeutic group or delays, treatment received with dose reductions or delays, treatment ne measured as the area under the receiver operating characteristic curve (AU
  • Figure 4 Decision-tree analysis showing the variables that significantly acute physiology and chronic health evaluation score; ECOG, Eastern Coopera

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Bernal, T., Pardavila, E. V., Bonastre, J., Jarque, I., Borges, M., Bargay, J., … Albaiceta, G. M. (2013). Survival of hematological patients after discharge from the intensive care unit: A prospective observational study. Critical Care, 17(6). https://doi.org/10.1186/cc13172

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