MORTALITY PREDICTORS IN PATIENTS WITH BLOOD MALIGNANCIES IN INTENSIVE CARE UNIT AFTER CHEMOTHERAPY.
(Abstract release date: 05/19/16)
EHA Library. Bakirov B. 06/09/16; 134799; PB1899
Dr. Bulat Bakirov
Contributions
Contributions
Abstract
Abstract: PB1899
Type: Publication Only
Background
The leading role in the treatment of malignant blood diseases belongs to high-dose chemotherapy. However, despite the high rates of successful treatment of hemoblastosis, the complications such as suppression of the immune system, septic neutropenia, DIC, multiple organ failure threaten the patient's life. The patients are transferred to the intensive care unit (ICU) for the treatment of such complications. The practical application of new treatment regimens and medications can successfully treat and stabilize patients in critical conditions. Despite this, currently there are groups of patients (especially those who have the extended lung ventilation and multiple organ failure) with poor prognosis of therapy outcome.
Aims
The identification of adverse outcome predictors allows to determine in time the treatment approach, which significantly reduces the risk of developing complications, the cost of treatment, significantly improving survival.
Methods
There was made a retrospective analysis of 138 adult patients in State Financed State Institution “Republican Clinical Hospital named after GG Kuvatova of Ufa” with malignant blood diseases, who received different chemotherapy protocols. However the complications developed, which required treatment of these patients in the intensive care unit. Critical analysis was made using the scales SOFA, LODS, ODIN, SAPS II, APACHE II, ICNARC model. Predisposing causes of hospital mortality for all patients were calculated according to the method of Knaus et al. Statistical analysis was made using Statistica package, 9.2. (StataCorp. LP, College Station, TX). The average age of patients - 28.7 years, AML (acute myeloid leukemia) - 88 patients (63.8%), ALL (acute lymphocytic leukemia) - 34 patients (24.6%) and 16 patients (11.6%) with other blood system diseases.
Results
The average time of a patient’s staying in the unit before being transferred to the intensive care unit: 7 days. At average, duration of stay in the ICU was 15.5 days. According to the results of staying in ICU the patients were divided into two groups. The first group included patients with fatal case - 47 patients. In this group 6 patients got artificial pulmonary ventilation (12.8%), 11 patients had neutropenia (23.4%), 14 patients had inotropic support (29.8%), 8 patients had a fungal infection (17.0%), 13 patients had a confirmed sepsis (27.7%) and 35 patients had trombocytes less 50x109/ l (74.5%). 35 patients had more than 2 of target affected organs (25.4%).
The second group included patients who were transferred from ICU with physical condition improvement - 91 patients, 17 patients have neutropenia (18.7%), 4 patients have fungal infection (4.4%), 26 patients have thrombocytes less 50х109 / L ( 28.6%), and 18 patients have sepsis (19.8%). 31 patients have more than 2 of target affected organs (22.5%).
According to the analysis of the first and second groups, the average score on APACHE II - 32 and 12, respectively, on-scale SAPS II - 76 and 34, SOFA - 20 and 5, LODS -4.05 and 6.4, ODIN -1.1 and 1.49.
Conclusion
The mortality predictors of patients in intensive care unit after chemotherapy are multiple organ failure (loss of 2 or more organ systems), as well as prolonged mechanical ventilation. Many other proposed criteria (eg, age, neutropenia, and data of physiological disturbance rating scales) should not be considered as an absolute outcome predictors of ongoing intensive care.
Session topic: E-poster
Type: Publication Only
Background
The leading role in the treatment of malignant blood diseases belongs to high-dose chemotherapy. However, despite the high rates of successful treatment of hemoblastosis, the complications such as suppression of the immune system, septic neutropenia, DIC, multiple organ failure threaten the patient's life. The patients are transferred to the intensive care unit (ICU) for the treatment of such complications. The practical application of new treatment regimens and medications can successfully treat and stabilize patients in critical conditions. Despite this, currently there are groups of patients (especially those who have the extended lung ventilation and multiple organ failure) with poor prognosis of therapy outcome.
Aims
The identification of adverse outcome predictors allows to determine in time the treatment approach, which significantly reduces the risk of developing complications, the cost of treatment, significantly improving survival.
Methods
There was made a retrospective analysis of 138 adult patients in State Financed State Institution “Republican Clinical Hospital named after GG Kuvatova of Ufa” with malignant blood diseases, who received different chemotherapy protocols. However the complications developed, which required treatment of these patients in the intensive care unit. Critical analysis was made using the scales SOFA, LODS, ODIN, SAPS II, APACHE II, ICNARC model. Predisposing causes of hospital mortality for all patients were calculated according to the method of Knaus et al. Statistical analysis was made using Statistica package, 9.2. (StataCorp. LP, College Station, TX). The average age of patients - 28.7 years, AML (acute myeloid leukemia) - 88 patients (63.8%), ALL (acute lymphocytic leukemia) - 34 patients (24.6%) and 16 patients (11.6%) with other blood system diseases.
Results
The average time of a patient’s staying in the unit before being transferred to the intensive care unit: 7 days. At average, duration of stay in the ICU was 15.5 days. According to the results of staying in ICU the patients were divided into two groups. The first group included patients with fatal case - 47 patients. In this group 6 patients got artificial pulmonary ventilation (12.8%), 11 patients had neutropenia (23.4%), 14 patients had inotropic support (29.8%), 8 patients had a fungal infection (17.0%), 13 patients had a confirmed sepsis (27.7%) and 35 patients had trombocytes less 50x109/ l (74.5%). 35 patients had more than 2 of target affected organs (25.4%).
The second group included patients who were transferred from ICU with physical condition improvement - 91 patients, 17 patients have neutropenia (18.7%), 4 patients have fungal infection (4.4%), 26 patients have thrombocytes less 50х109 / L ( 28.6%), and 18 patients have sepsis (19.8%). 31 patients have more than 2 of target affected organs (22.5%).
According to the analysis of the first and second groups, the average score on APACHE II - 32 and 12, respectively, on-scale SAPS II - 76 and 34, SOFA - 20 and 5, LODS -4.05 and 6.4, ODIN -1.1 and 1.49.
Conclusion
The mortality predictors of patients in intensive care unit after chemotherapy are multiple organ failure (loss of 2 or more organ systems), as well as prolonged mechanical ventilation. Many other proposed criteria (eg, age, neutropenia, and data of physiological disturbance rating scales) should not be considered as an absolute outcome predictors of ongoing intensive care.
Session topic: E-poster
Abstract: PB1899
Type: Publication Only
Background
The leading role in the treatment of malignant blood diseases belongs to high-dose chemotherapy. However, despite the high rates of successful treatment of hemoblastosis, the complications such as suppression of the immune system, septic neutropenia, DIC, multiple organ failure threaten the patient's life. The patients are transferred to the intensive care unit (ICU) for the treatment of such complications. The practical application of new treatment regimens and medications can successfully treat and stabilize patients in critical conditions. Despite this, currently there are groups of patients (especially those who have the extended lung ventilation and multiple organ failure) with poor prognosis of therapy outcome.
Aims
The identification of adverse outcome predictors allows to determine in time the treatment approach, which significantly reduces the risk of developing complications, the cost of treatment, significantly improving survival.
Methods
There was made a retrospective analysis of 138 adult patients in State Financed State Institution “Republican Clinical Hospital named after GG Kuvatova of Ufa” with malignant blood diseases, who received different chemotherapy protocols. However the complications developed, which required treatment of these patients in the intensive care unit. Critical analysis was made using the scales SOFA, LODS, ODIN, SAPS II, APACHE II, ICNARC model. Predisposing causes of hospital mortality for all patients were calculated according to the method of Knaus et al. Statistical analysis was made using Statistica package, 9.2. (StataCorp. LP, College Station, TX). The average age of patients - 28.7 years, AML (acute myeloid leukemia) - 88 patients (63.8%), ALL (acute lymphocytic leukemia) - 34 patients (24.6%) and 16 patients (11.6%) with other blood system diseases.
Results
The average time of a patient’s staying in the unit before being transferred to the intensive care unit: 7 days. At average, duration of stay in the ICU was 15.5 days. According to the results of staying in ICU the patients were divided into two groups. The first group included patients with fatal case - 47 patients. In this group 6 patients got artificial pulmonary ventilation (12.8%), 11 patients had neutropenia (23.4%), 14 patients had inotropic support (29.8%), 8 patients had a fungal infection (17.0%), 13 patients had a confirmed sepsis (27.7%) and 35 patients had trombocytes less 50x109/ l (74.5%). 35 patients had more than 2 of target affected organs (25.4%).
The second group included patients who were transferred from ICU with physical condition improvement - 91 patients, 17 patients have neutropenia (18.7%), 4 patients have fungal infection (4.4%), 26 patients have thrombocytes less 50х109 / L ( 28.6%), and 18 patients have sepsis (19.8%). 31 patients have more than 2 of target affected organs (22.5%).
According to the analysis of the first and second groups, the average score on APACHE II - 32 and 12, respectively, on-scale SAPS II - 76 and 34, SOFA - 20 and 5, LODS -4.05 and 6.4, ODIN -1.1 and 1.49.
Conclusion
The mortality predictors of patients in intensive care unit after chemotherapy are multiple organ failure (loss of 2 or more organ systems), as well as prolonged mechanical ventilation. Many other proposed criteria (eg, age, neutropenia, and data of physiological disturbance rating scales) should not be considered as an absolute outcome predictors of ongoing intensive care.
Session topic: E-poster
Type: Publication Only
Background
The leading role in the treatment of malignant blood diseases belongs to high-dose chemotherapy. However, despite the high rates of successful treatment of hemoblastosis, the complications such as suppression of the immune system, septic neutropenia, DIC, multiple organ failure threaten the patient's life. The patients are transferred to the intensive care unit (ICU) for the treatment of such complications. The practical application of new treatment regimens and medications can successfully treat and stabilize patients in critical conditions. Despite this, currently there are groups of patients (especially those who have the extended lung ventilation and multiple organ failure) with poor prognosis of therapy outcome.
Aims
The identification of adverse outcome predictors allows to determine in time the treatment approach, which significantly reduces the risk of developing complications, the cost of treatment, significantly improving survival.
Methods
There was made a retrospective analysis of 138 adult patients in State Financed State Institution “Republican Clinical Hospital named after GG Kuvatova of Ufa” with malignant blood diseases, who received different chemotherapy protocols. However the complications developed, which required treatment of these patients in the intensive care unit. Critical analysis was made using the scales SOFA, LODS, ODIN, SAPS II, APACHE II, ICNARC model. Predisposing causes of hospital mortality for all patients were calculated according to the method of Knaus et al. Statistical analysis was made using Statistica package, 9.2. (StataCorp. LP, College Station, TX). The average age of patients - 28.7 years, AML (acute myeloid leukemia) - 88 patients (63.8%), ALL (acute lymphocytic leukemia) - 34 patients (24.6%) and 16 patients (11.6%) with other blood system diseases.
Results
The average time of a patient’s staying in the unit before being transferred to the intensive care unit: 7 days. At average, duration of stay in the ICU was 15.5 days. According to the results of staying in ICU the patients were divided into two groups. The first group included patients with fatal case - 47 patients. In this group 6 patients got artificial pulmonary ventilation (12.8%), 11 patients had neutropenia (23.4%), 14 patients had inotropic support (29.8%), 8 patients had a fungal infection (17.0%), 13 patients had a confirmed sepsis (27.7%) and 35 patients had trombocytes less 50x109/ l (74.5%). 35 patients had more than 2 of target affected organs (25.4%).
The second group included patients who were transferred from ICU with physical condition improvement - 91 patients, 17 patients have neutropenia (18.7%), 4 patients have fungal infection (4.4%), 26 patients have thrombocytes less 50х109 / L ( 28.6%), and 18 patients have sepsis (19.8%). 31 patients have more than 2 of target affected organs (22.5%).
According to the analysis of the first and second groups, the average score on APACHE II - 32 and 12, respectively, on-scale SAPS II - 76 and 34, SOFA - 20 and 5, LODS -4.05 and 6.4, ODIN -1.1 and 1.49.
Conclusion
The mortality predictors of patients in intensive care unit after chemotherapy are multiple organ failure (loss of 2 or more organ systems), as well as prolonged mechanical ventilation. Many other proposed criteria (eg, age, neutropenia, and data of physiological disturbance rating scales) should not be considered as an absolute outcome predictors of ongoing intensive care.
Session topic: E-poster
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