Long-term survival and functional outcomes of critically ill patients with hematologic malignancies: a Canadian multicenter prospective study.

Autor: 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.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Laveena.munshi@sinaihealth.ca., Dumas G; Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France., Rochwerg B; Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada., Shoukat F; 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., Detsky M; 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., Fergusson DA; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Medicine, University of Ottawa, Ottawa, ON, 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.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada., Heffernan P; Department of Medicine at Queen's University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada., Herridge M; Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada., Magder S; Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.; Critical Care Department, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada., Minden M; Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada., Patel R; Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.; Department of Critical Care Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada., Qureshi S; Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada., Schimmer A; Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada., Thyagu S; Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada., Wang HT; Division of Critical Care MedicineDepartment of Medicine at Hopital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada., Mehta 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.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Apr; Vol. 50 (4), pp. 561-572. Date of Electronic Publication: 2024 Mar 11.
DOI: 10.1007/s00134-024-07349-z
Abstrakt: 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.
(© 2024. Crown.)
Databáze: MEDLINE
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