Elderly AML: which factors predict in-hospital mortality after ICU admission?

  • Slavin SD & al.
  • Cancer
  • 12 Jul 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In older patients with acute myeloid leukemia (AML) admitted to an intensive care unit (ICU), performance status before ICU admission and need for life-sustaining therapies are important prognostic factors that may assist clinicians in making optimal use of resources.

Why this matters

  • ICU-related treatment decisions may be better implemented with estimations of patients most likely to benefit.

Study design

  • Study to investigate outcomes in older adults with AML after first admission to ICU.
  • 330 patients were included in the study.
  • Median patient age, 69 (range, 60-90) years.
  • All patients were newly diagnosed with AML at a single institution in the United States between 2005 and 2013. 
  • Funding: National Cancer Institute's Federal Share Program.

Key results

  • 29.1% of patients (96/330) were admitted to the ICU.
  • Primary indications for ICU admission: respiratory failure (39%), septic shock (28%), neurological compromise (9%).
  • 64% of those alive at discharge remained alive at 1 year.
  • Factors significantly associated with increased odds of in-hospital mortality in multivariate analysis:
    • Poorer Eastern Cooperative Oncology Group status before ICU: OR, 2.76; 95% CI, 1.24-6.12; P=.013.
    • Need for ≥2 life-sustaining therapies: OR, 12.39; 95% CI, 3.10-49.48; P<.001.>

Limitations

  • Retrospective data.