Evaluation of clinical features and results of patients followed up in the intensive care unit with the diagnosis of hematological cancer: a single center experience

Abstract

Introduction: Patients diagnosed with hematological cancer (HC) often need intensive care during their follow-up and treatment. In this study, it was aimed to evaluate the clinical characteristics and follow-up results of patients diagnosed with HC who were followed up in the intensive care unit (ICU). Materials and methods: This is a retrospective study enrolling 77 adult HC patients requiring intensive care between February 2019 and March, 2020. Results: Thirty-eight (50.6%) patients included in the study were neutropenic and 67 patients (87%) had infection during admission to the ICU. Acute myeloid leukemia was diagnosed in 35 (45.5%) patients. Mechanical ventilation was applied to 56 (72.7%) patients on admission. In the follow-up, 32 (41.6%) patients developed ICU infection, 24 (31.2%) patients developed bacteremia. The most common pathogens were; Klebsiella pneumonia (n = 11, 14.3%) and non-fermentation bacteria (n = 13, 16.6%) were gram-negative bacilli. Overall ICU survival rate was 32.5% (n: 25). Variables predicted to affect mortality in univariate analysis; APACHE II score ≥ 25 (p <0.001), resistance to cancer treatment or relapse (p = 0.015), septic shock at hospitalization (p <0.001), need for invasive mechanical ventilation (p <0.001) and presence of hospital infection (p = 0.006) were statistically were found to be significant risk factors. As a result of the multivariate model established with these variables, it was seen that the APACHE II score was a significant predictor for mortality (ROC: 0.884). Conclusion: APACHE II score 25 and septic shock are important poor prognosis criteria. Successful treatment and long survival can be achieved by the protocols to be determined in the follow-up and treatment of HC patients in need of intensive care, supportive treatments and prevention of nosocomial infections.

Keywords

• intensive care unit
• hematological cancer
• infection

Hematolojik kanser tanısıyla yoğun bakım ünitesinde takip edilen hastaların klinik özelliklerinin ve sonuçlarının değerlendirilmesi: tek merkez deneyimi

Öz

Giriş: Hematolojik kanser (HK) tanısı alan hastaların takip ve tedavisi sırasında sıklıkla yoğun bakım ihtiyacı olmaktadır. Bu çalışma ile yoğun bakım ünitesinde (YBÜ) takip edilen HK tanısı almış hastaların, klinik özellikleri ve takip sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Bu çalışmada, Şubat 2019 ile Mart 2020 tarihleri arasında yoğun bakım takibi gerektiren 77 erişkin hastanın kayıtları geriye dönük olarak incelenmiştir. Bulgular: Çalışmaya alınan, 38 (%50,6) hasta nötropenikti ve YBÜ'ne yatış sırasında 67 hastada (%87) enfeksiyon vardı. 35 (%45,5) hastaya akut miyeloid lösemi tanısı konmuştu. 56 (%72,7) hastaya yatışta mekanik ventilasyon uygulanmıştı. İzlemde 32 (%41,6) hastada YBÜ enfeksiyonu, 24 (%31,2) hastada bakteriyemi gelişmiş olup en sık saptanan patojenler; gram-negatif basillerden Klebsiella pneumonia (n=11, %14,3) ve fermentasyon yapmayan bakterilerdi (n=13, %16,6). Genel YBÜ sağ kalım oranı %32,5 (n:25) idi. Tek değişkenli analizde mortaliteyi etkilediği ön görülen değişkenler; APACHE II skoru ≥ 25 (p<0,001), kanser tedavisine direnç veya relaps (p=0.015), yatışta septik şok (p<0.001), invaziv mekanik ventilasyon ihtiyacı (p<0,001) ve hastane enfeksiyon varlığı (p=0,006) istatistiksel olarak anlamlı risk faktörleri olarak saptandı. Bu değişkenler ile kurulan çok değişkenli model sonucunda ise APACHE II skorunun mortalite için anlamlı bir tahmin edici olduğu görüldü (ROC:0.884) . Sonuç: APACHE II skoru≥25 ve septik şok önemli kötü prognoz kriterleridir. Yoğun bakım ihtiyacı olan HK hastalarının takip ve tedavisinde belirlenecek protokoller, destekleyici tedaviler ve hastane enfeksiyonlarının önlenmesi ile tedavi başarısının ve yaşam süresinin uzatılması sağlanabilir.

Anahtar Kelimeler

• yoğun bakım ünitesi
• hematolojik kanser
• enfeksiyon

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