Research Article
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The factors affecting survival in patients followed up with the diagnosis of lymphoma in the intensive care unit

Year 2023, Volume: 48 Issue: 3, 1007 - 1015, 30.09.2023
https://doi.org/10.17826/cumj.1344207

Abstract

Purpose: This retrospective analysis aimed to elucidate the key factors influencing survival outcomes in patients diagnosed with lymphoma and admitted to an Intensive Care Unit (ICU).
Materials and Methods: The study cohort comprised individuals aged 18 or older diagnosed with lymphoma and admitted to the ICU between November 2015 and February 2023. Data were collected on patients' demographic characteristics, primary hematological diagnoses, reasons for ICU admission, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, clinical trajectory, and 28-day mortality rates. Patients were stratified into two categories based on their mortality outcomes: Survivors and non-survivors.
Results: A total of 165 patients were included in the study, with a mean age of 52.41 ± 17.99 years; 63% were male. Table 1 summarizes the demographic characteristics, clinical trajectories, and 28-day mortality rates. The APACHE II and SOFA scores of the patients were 34 (7–53) and 12 (10–14), respectively. The predominant reasons for ICU admission were sepsis (58.2%) and acute respiratory failure (57.6%). Vasopressor necessity prior to and during ICU stay was 23.6% and 92.4%, respectively. During ICU monitoring, thrombocytopenia, and acute kidney injury (AKI) were observed in 77.6% and 66.4% of patients, respectively; 10% required renal replacement therapy. The 28-day mortality rate was 84.8%. Kaplan-Meier analysis revealed that patients with a SOFA score ≥ 9 had a significantly reduced survival time of 4.5 ± 0.4 days compared to those with lower SOFA scores (14.3 ± 2.6 days). Patients with AKI and those requiring invasive mechanical ventilation (IMV) exhibited reduced survival times of 4.7 ± 0.5 days and 5.6 ± 0.5 days, respectively. Elevated SOFA scores (HR 2.355, 95% CI 1.485–3.734), presence of AKI (HR 1.511, 95% CI 1.055–2.163), and the need for IMV (HR 5.721, 95% CI 1.377–23.770) were significantly correlated with increased 28-day mortality. Receiver Operating Characteristic (ROC) curve analysis identified the optimal SOFA cut-off point for predicting 28-day mortality as nine, with an Area Under the Curve (AUC) of 0.897, sensitivity 83.6% and specificity 92%.
Conclusions: The findings of this study underscore the elevated mortality rates among lymphoma patients admitted to the ICU. Our data suggest that several factors serve as significant predictors of 28-day mortality in this patient population. Specifically, elevated APACHE II scores, SOFA scores, the presence of AKI, and the requirement for IMV emerged as crucial indicators associated with adverse survival outcomes. Consequently, these factors warrant meticulous monitoring and could inform targeted interventions to improve survival rates among lymphoma patients in critical care settings.

Thanks

Bu çalışma, 16th World Intensive and Critical Care Congress’inde (26-30 Ağustos 2023) poster bildirisi olarak kabul edildi. Yazarlar, istatistiksel analize katkıda bulunan Yusuf Kemal Arslan'a teşekkür eder.

References

  • Irie H, Otake T, Kawai K, Hino M, Namazu A, Shinjo Y et al. Prognostic factors in critically ill patients with hematological malignancy admitted to the general intensive care unit: a single-center experience in Japan. J Anesth. 2017;31:736-43.
  • Grgić Medić M, Gornik I, Gašparović V. Hematologic malignancies in the medical intensive care unit--Outcomes and prognostic factors. Hematology. 2015;20:247-53.
  • Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R et al. Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med. 2021;47:1104-14.
  • Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E et al. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med. 2005;33:2488-93.
  • Larché J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29:1688-95.
  • Massion PB, Dive AM, Doyen C, Bulpa P, Jamart J, Bosly A et al. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med. 2002;30:2260-70.
  • Kalicińska E, Kuszczak B, Dębski J, Szukalski Ł, Wątek M, Strzała J et al. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit? Support Care Cancer. 2021;29:323-30.
  • Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth. 2012;108:452-9.
  • Bıkmaz ŞGA, Gökçe O, Haşimoğlu MM, Boyacı N, Türkoğlu M, Yeğin ZA et al Risk factors for ICU mortality in patients with hematological malignancies: a singlecenter, retrospective cohort study from Turkey. Turk J Med Sci. 2023;53:340-51.
  • Rawson JL, Fagan FM, Burrough GC, Tang HM, Cuncannon MA, Ellem KL et al. Intensive care unit outcomes in patients with hematological malignancy. Blood Sci. 2020;2:33-7.
  • Mokart D, Lambert J, Schnell D, Fouché L, Rabbat A, Kouatchet A et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma. 2013;54:1724-9.
  • Zduniak A, Mihailescu SD, Lequesne J, Lenain P, Contentin N, Pepin LF et al. Outcomes after intensive care unit admission in newly diagnosed diffuse large B-cell lymphoma patients: A real-life study. Eur J Haematol. 2021;106:788-99.
  • Qi J, Gu C, Wang W, Xiang M, Chen X, Fu J. Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin's Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation. Front Oncol. 2021;11:753712.
  • Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158:825-30.
  • Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-6.
  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.
  • Quintairos A, Pilcher D, Salluh JIF. ICU scoring systems. Intensive Care Med. 2023;49:223-25.
  • Türk Toraks Derneği. Erişkinlerde Hastanede Gelişen Pnömoni Tanı Ve Tedavi Uzlaşı Raporu 2018. Ankara, Türk Toraks Derneği, 2018..
  • Maqsood S, Badar F, Hameed A. Characteristics . Asian Pac J Cancer Prev. 2017;18:1833-7.
  • Park MR, Jeon K, Song JU, Lim SY, Park SY, Lee JE et al. Outcomes in critically ill patients with hematologic malignancies who received renal replacement therapy for acute kidney injury in an intensive care unit. J Crit Care. 2011;26:107.e1-6.
  • Bernal T, Pardavila EV, Bonastre J, Jarque I, Borges M, Bargay J et al. Survival of hematological patients after discharge from the intensive care unit: a prospective observational study. Crit Care. 2013;17:R302.
  • Zong X, Gu Y, Yu H, Li Z, Wang Y. Thrombocytopenia is associated with COVID-19 severity and outcome: an updated meta-analysis of 5637 patients with multiple outcomes. Lab Med. 2021;52:10-5.
  • Shragai T, Lebel E, Deshet D, Varon D, Avivi I, Kirgner I et al. Characteristics and outcomes of adults with cytomegalovirus-associated thrombocytopenia: a case series and literature review. Br J Haematol. 2020;191:863-7.
  • Maray I, Rodríguez-Ferreras A, Álvarez-Asteinza C, Alaguero-Calero M, Valledor P, Fernández J. Linezolid induced thrombocytopenia in critically ill patients: Risk factors and development of a machine learning-based prediction model. J Infect Chemother. 2022:1249-54.
  • Wu TKY, Tang KHK, Hwang YY, Chan TSY, Tse E, Kwong YL. Bendamustine treatment of haematological malignancies: significant risks of opportunistic viral, fungal and bacterial infections. Hematology. 2022;27:535-42.
  • Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589-96.
  • Judickas Š, Stasiūnaitis R, Žučenka A, Žvirblis T, Šerpytis M, Šipylaitė J. Outcomes and risk factors of critically ill patients with hematological malignancy. prospective single-centre observational study. Medicina (Kaunas). 2021;57:1317.
  • Patel P, Gupta S, Patel H, Bashar MA. Assessment of APACHE II Score to Predict ICU outcomes of patients with AKI: A single-center experience from Haryana, North India. Indian J Crit Care Med. 2022;26:276-81.
  • Geerse DA, Span LF, Pinto-Sietsma SJ, van Mook WN. Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality. Eur J Intern Med. 2011;22:57-61.
  • Vandijck DM, Depuydt PO, Offner FC, Nollet J, Peleman RA, Steel E et al. Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. Intensive Care Med. 2010;36:1744–50.
  • Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J et al. 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. 2013;31:2810-8.

Yoğun bakım ünitesinde lenfoma tanısı ile takip edilen hastalarda sağkalımı etkileyen faktörler

Year 2023, Volume: 48 Issue: 3, 1007 - 1015, 30.09.2023
https://doi.org/10.17826/cumj.1344207

Abstract

Amaç: Bu retrospektif analiz, lenfoma tanısı konan ve Yoğun Bakım Ünitesine (YBÜ) yatırılan hastalarda sağkalım sonuçlarını etkileyen temel faktörleri aydınlatmayı amaçlamıştır.
Gereç ve Yöntem: Çalışma grubu, Kasım 2015 ile Şubat 2023 arasında lenfoma tanısı konan ve YBÜ'ye kabul edilen 18 yaş ve üzeri bireylerden oluşmaktadır. Hastaların demografik özellikleri, birincil hematolojik tanıları, YBÜ'ye kabul nedenleri, laboratuvar parametreleri, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II skorları, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skorları, klinik seyirleri ve 28 günlük mortalite oranları hakkında veriler toplanmıştır. Hastalar mortalite sonuçlarına göre iki kategoriye ayrılmıştır: Hayatta kalanlar ve ölenler.
Bulgular: Ortalama yaşı 52,41 ± 17,99 yıl olan toplam 165 hasta çalışmaya dahil edilmiştir; hastaların %63'ü erkektir. Tablo 1 demografik özellikleri, klinik seyirleri ve 28 günlük mortalite oranlarını özetlemektedir. Hastaların APACHE II ve SOFA skorları sırasıyla 34 (7-53) ve 12 (10-14)’idi. YBÜ'ye kabulün başlıca nedenleri sepsis (%58,2) ve akut solunum yetmezliğiydi (%57,6). YBÜ'de kalış öncesinde ve sırasında vazopressör ihtiyacı sırasıyla %23,6 ve %92,4 idi. YBÜ izlemi sırasında hastaların sırasıyla %77,6 ve %66,4'ünde trombositopeni ve akut böbrek hasarı (ABH) gözlendi; %10'unda renal replasman tedavisi gerekti. 28 günlük mortalite oranı %84,8 idi. Kaplan-Meier analizi, SOFA skoru ≥ 9 olan hastaların sağkalım süresinin SOFA skoru daha düşük olanlara kıyasla (14,3 ± 2,6 gün) 4,5 ± 0,4 gün daha kısa olduğunu ortaya koymuştur. Akut böbrek hasarı olan ve invaziv mekanik ventilasyon (IMV) gerektiren hastalarda sırasıyla 4,7 ± 0,5 gün ve 5,6 ± 0,5 günlük azalmış sağkalım süreleri görülmüştür. Yüksek SOFA skorları (HR 2.355, %95 CI 1.485-3.734), AKI varlığı (HR 1.511, %95 CI 1.055-2.163) ve IMV ihtiyacı (HR 5.721, %95 CI 1.377-23.770) artmış 28 günlük mortalite ile anlamlı şekilde ilişkiliydi. Alıcı İşlem Karakteristiği (ROC) eğrisi analizi, 28 günlük ölüm oranını tahmin etmede optimal SOFA kesme noktasını dokuz olarak tanımladı; Eğri Altındaki Alan (AUC) 0,897, duyarlılık %83,6 ve özgüllük %92'idi.
Sonuç: Bu çalışmanın bulguları, YBÜ'ye kabul edilen lenfoma hastaları arasındaki yüksek mortalite oranlarının altını çizmektedir. Verilerimiz, bu hasta popülasyonunda çeşitli faktörlerin 28 günlük mortalitenin önemli belirleyicileri olduğunu göstermektedir. Özellikle, yüksek APACHE II skorları, SOFA skorları, AKI varlığı ve IMV gereksinimi, olumsuz sağkalım sonuçlarıyla ilişkili önemli göstergeler olarak ortaya çıkmıştır. Sonuç olarak, bu faktörler titiz bir izlem gerektirmektedir ve kritik bakım ortamlarındaki lenfoma hastalarındaki sağkalım oranlarını iyileştirmek için hedeflenen müdahaleler hakkında bilgi verebilir.

References

  • Irie H, Otake T, Kawai K, Hino M, Namazu A, Shinjo Y et al. Prognostic factors in critically ill patients with hematological malignancy admitted to the general intensive care unit: a single-center experience in Japan. J Anesth. 2017;31:736-43.
  • Grgić Medić M, Gornik I, Gašparović V. Hematologic malignancies in the medical intensive care unit--Outcomes and prognostic factors. Hematology. 2015;20:247-53.
  • Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R et al. Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med. 2021;47:1104-14.
  • Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E et al. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med. 2005;33:2488-93.
  • Larché J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29:1688-95.
  • Massion PB, Dive AM, Doyen C, Bulpa P, Jamart J, Bosly A et al. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med. 2002;30:2260-70.
  • Kalicińska E, Kuszczak B, Dębski J, Szukalski Ł, Wątek M, Strzała J et al. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit? Support Care Cancer. 2021;29:323-30.
  • Bird GT, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth. 2012;108:452-9.
  • Bıkmaz ŞGA, Gökçe O, Haşimoğlu MM, Boyacı N, Türkoğlu M, Yeğin ZA et al Risk factors for ICU mortality in patients with hematological malignancies: a singlecenter, retrospective cohort study from Turkey. Turk J Med Sci. 2023;53:340-51.
  • Rawson JL, Fagan FM, Burrough GC, Tang HM, Cuncannon MA, Ellem KL et al. Intensive care unit outcomes in patients with hematological malignancy. Blood Sci. 2020;2:33-7.
  • Mokart D, Lambert J, Schnell D, Fouché L, Rabbat A, Kouatchet A et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma. 2013;54:1724-9.
  • Zduniak A, Mihailescu SD, Lequesne J, Lenain P, Contentin N, Pepin LF et al. Outcomes after intensive care unit admission in newly diagnosed diffuse large B-cell lymphoma patients: A real-life study. Eur J Haematol. 2021;106:788-99.
  • Qi J, Gu C, Wang W, Xiang M, Chen X, Fu J. Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin's Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation. Front Oncol. 2021;11:753712.
  • Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158:825-30.
  • Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250-6.
  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.
  • Quintairos A, Pilcher D, Salluh JIF. ICU scoring systems. Intensive Care Med. 2023;49:223-25.
  • Türk Toraks Derneği. Erişkinlerde Hastanede Gelişen Pnömoni Tanı Ve Tedavi Uzlaşı Raporu 2018. Ankara, Türk Toraks Derneği, 2018..
  • Maqsood S, Badar F, Hameed A. Characteristics . Asian Pac J Cancer Prev. 2017;18:1833-7.
  • Park MR, Jeon K, Song JU, Lim SY, Park SY, Lee JE et al. Outcomes in critically ill patients with hematologic malignancies who received renal replacement therapy for acute kidney injury in an intensive care unit. J Crit Care. 2011;26:107.e1-6.
  • Bernal T, Pardavila EV, Bonastre J, Jarque I, Borges M, Bargay J et al. Survival of hematological patients after discharge from the intensive care unit: a prospective observational study. Crit Care. 2013;17:R302.
  • Zong X, Gu Y, Yu H, Li Z, Wang Y. Thrombocytopenia is associated with COVID-19 severity and outcome: an updated meta-analysis of 5637 patients with multiple outcomes. Lab Med. 2021;52:10-5.
  • Shragai T, Lebel E, Deshet D, Varon D, Avivi I, Kirgner I et al. Characteristics and outcomes of adults with cytomegalovirus-associated thrombocytopenia: a case series and literature review. Br J Haematol. 2020;191:863-7.
  • Maray I, Rodríguez-Ferreras A, Álvarez-Asteinza C, Alaguero-Calero M, Valledor P, Fernández J. Linezolid induced thrombocytopenia in critically ill patients: Risk factors and development of a machine learning-based prediction model. J Infect Chemother. 2022:1249-54.
  • Wu TKY, Tang KHK, Hwang YY, Chan TSY, Tse E, Kwong YL. Bendamustine treatment of haematological malignancies: significant risks of opportunistic viral, fungal and bacterial infections. Hematology. 2022;27:535-42.
  • Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589-96.
  • Judickas Š, Stasiūnaitis R, Žučenka A, Žvirblis T, Šerpytis M, Šipylaitė J. Outcomes and risk factors of critically ill patients with hematological malignancy. prospective single-centre observational study. Medicina (Kaunas). 2021;57:1317.
  • Patel P, Gupta S, Patel H, Bashar MA. Assessment of APACHE II Score to Predict ICU outcomes of patients with AKI: A single-center experience from Haryana, North India. Indian J Crit Care Med. 2022;26:276-81.
  • Geerse DA, Span LF, Pinto-Sietsma SJ, van Mook WN. Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality. Eur J Intern Med. 2011;22:57-61.
  • Vandijck DM, Depuydt PO, Offner FC, Nollet J, Peleman RA, Steel E et al. Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies. Intensive Care Med. 2010;36:1744–50.
  • Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J et al. 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. 2013;31:2810-8.
There are 31 citations in total.

Details

Primary Language English
Subjects Intensive Care
Journal Section Research
Authors

Kaniye Aydın 0000-0001-5538-3692

Ömer Doğan 0009-0003-5347-7718

Early Pub Date September 26, 2023
Publication Date September 30, 2023
Acceptance Date September 11, 2023
Published in Issue Year 2023 Volume: 48 Issue: 3

Cite

MLA Aydın, Kaniye and Ömer Doğan. “The Factors Affecting Survival in Patients Followed up With the Diagnosis of Lymphoma in the Intensive Care Unit”. Cukurova Medical Journal, vol. 48, no. 3, 2023, pp. 1007-15, doi:10.17826/cumj.1344207.