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Secreto C, Chean D, van de Louw A, Kouatchet A, Bauer P, Cerrano M, Lengliné E, Saillard C, Chow-Chine L, Perner A, Pickkers P, Soares M, Rello J, Pène F, Lemiale V, Darmon M, Fodil S, Martin-Loeches I, Mehta S, Schellongowski P, Azoulay E, Mokart D. Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study. Ann Intensive Care 2023; 13:79. [PMID: 37658994 PMCID: PMC10474995 DOI: 10.1186/s13613-023-01172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed. METHODS This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis. RESULTS Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality. CONCLUSIONS Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.
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Affiliation(s)
- Carolina Secreto
- Division of Haematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy.
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
| | - Dara Chean
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris Cité University, Paris, France
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Philippe Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marco Cerrano
- Division of Haematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy
| | - Etienne Lengliné
- Hématologie Adulte, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Colombe Saillard
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação Em Clínica Médica, Rio De Janeiro, Brazil
| | - Jordi Rello
- Vall d'Hebron Institute of Research, Barcelona, Spain
- CHU Nîmes, Université de Nîmes-Montpellier, Nîmes, France
| | - Frédéric Pène
- Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Sofiane Fodil
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | | | - Sangeeta Mehta
- Sinai Health System and University of Toronto, Toronto, ON, Canada
| | | | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
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Garcia Borrega J, Böll B, Kochanek M, Naendrup JH, Simon F, Sieg N, Hallek M, Borchmann P, Holtick U, Shimabukuro-Vornhagen A, Eichenauer DA, Heger JM. Characteristics and outcomes of patients undergoing high-dose chemotherapy and autologous stem cell transplantation admitted to the intensive care unit: a single-center retrospective analysis. Ann Hematol 2023; 102:191-197. [PMID: 36394583 PMCID: PMC9807528 DOI: 10.1007/s00277-022-05028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplantation (ASCT) can be associated with adverse events necessitating treatment on the intensive care unit (ICU). Data focusing on patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT are scarce. We thus conducted a single-center retrospective analysis comprising 79 individuals who had high-dose chemotherapy and ASCT between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after ASCT. The median age was 57 years (range: 20-82 years); 38% of patients were female. B-cell non-Hodgkin lymphoma (34%) and plasma cell disorders (28%) were the most common indications for high-dose chemotherapy and ASCT. Sepsis represented the major cause for ICU admission (68%). Twenty-nine percent of patients required mechanical ventilation (MV), 5% had renal replacement therapy, and 44% needed vasopressors. The ICU, hospital, 90-day, and 1-year survival rates were 77.2%, 77.2%, 72.2%, and 60.3%, respectively. Stable disease or disease progression prior to the initiation of high-dose chemotherapy (p = 0.0028) and MV (p < 0.0001) were associated with an impaired survival. A total of 36 patients died during observation. The most frequent causes of death were the underlying malignancy (44%) and sepsis (39%). Taken together, the present analysis indicates a favorable overall outcome for patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT. Thus, this patient group should not be denied admission and treatment on the ICU.
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Affiliation(s)
- Jorge Garcia Borrega
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Florian Simon
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Noelle Sieg
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Michael Hallek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Udo Holtick
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Dennis A. Eichenauer
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Michel Heger
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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