Your browser doesn't support javascript.
loading
Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study.
Munshi, Laveena; Dumas, Guillaume; Rochwerg, Bram; Shoukat, Farah; Detsky, Michael; Fergusson, Dean A; Ferreyro, Bruno L; Heffernan, Paul; Herridge, Margaret; Magder, Sheldon; Minden, Mark; Patel, Rakesh; Qureshi, Salman; Schimmer, Aaron; Thyagu, Santhosh; Wang, Han Ting; Mehta, Sangeeta.
Affiliation
  • 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.
  • Dumas G; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Laveena.munshi@sinaihealth.ca.
  • Rochwerg B; Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France.
  • Shoukat F; Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada.
  • Detsky M; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
  • Fergusson DA; 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.
  • 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.
  • Heffernan P; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Herridge M; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Magder 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.
  • Minden M; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
  • Patel R; Department of Medicine at Queen's University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
  • Qureshi S; Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
  • Schimmer A; Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
  • Thyagu S; Critical Care Department, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
  • Wang HT; Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Mehta S; Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Intensive Care Med ; 50(4): 561-572, 2024 Apr.
Article in En | MEDLINE | ID: mdl-38466402
ABSTRACT

PURPOSE:

Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hematologic Neoplasms / Frailty Limits: Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Intensive Care Med Year: 2024 Document type: Article Affiliation country: Canadá Country of publication: Estados Unidos

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hematologic Neoplasms / Frailty Limits: Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Intensive Care Med Year: 2024 Document type: Article Affiliation country: Canadá Country of publication: Estados Unidos