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van Beers EJ, Müller MCA, Vlaar APJ, Spanjaard L, van den Bergh WM. Haematological malignancy in the intensive care unit: microbiology results and mortality. Eur J Haematol 2016; 97:271-7. [PMID: 26676382 DOI: 10.1111/ejh.12721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mortality prediction models of patients with a haematological malignancy admitted to an intensive care unit (ICU) do not include the presence of neutropenia and microbiology results. We performed a registry-based retrospective study of haematology patients admitted to the ICU to investigate the relation between neutropenia, microbiology results and outcome of these patients. METHODS Neutropenia and microbiology culture results within 24 h before or after ICU admission of patients with a haematological malignancy admitted between 2004 and 2010 were described and analysed for association with 28-day mortality. RESULTS We identified 234 individual patients with a current malignant haematological condition, of which 27% were neutropenic and 21% had a positive blood culture at admission. Most prevalent from blood cultured species were Escherichia coli and coagulase-negative staphylococci. The overall 28-day mortality was 38%. In patients with a positive blood culture but no neutropenia, 28-day mortality was 28% and in patients with neutropenia but without positive blood culture, it was 36%. The 28-day mortality of patients with both neutropenia and a positive blood culture was 55% with an adjusted (for APACHE-II score) hazard ratio (HR) of 1.8 (95%CI 1.0-3.4) compared to other hematologic patients admitted to the ICU. CONCLUSION In patients with haematological malignancy admitted to the ICU, culture results are diverse. The combination of neutropenia and positive blood culture is associated with increased 28-day mortality. We suggest this could be of additional value when assessing mortality risk in this patient group.
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Affiliation(s)
- Eduard Johannes van Beers
- Van Creveldkliniek, University Medical Center, Utrecht, the Netherlands.,Department of Clinical Haematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marcella Catharina Antoinetta Müller
- Department of Intensive Care Medicine, Medisch Centrum Haaglanden, The Hague, the Netherlands.,Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Lodewijk Spanjaard
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Walter Marcel van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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José RJP, Mohammed AO, Goldring JJP, Chambers RC, Brown JS, Agarwal B. Cancer patients with community-acquired pneumonia treated in intensive care have poorer outcomes associated with increased illness severity and septic shock at admission to intensive care: a retrospective cohort study. Pneumonia (Nathan) 2015; 6:77-82. [PMID: 31641581 PMCID: PMC5922332 DOI: 10.15172/pneu.2015.6/645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/28/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with community-acquired pneumonia (CAP) and an underlying diagnosis of cancer have worse outcomes. However, the characteristics of cancer patients with CAP admitted to intensive care units (ICUs) are not well established. In a retrospective observational study, patients admitted to a London university hospital ICU between January 2006 and October 2011 with a primary diagnosis of CAP were included. Demographic, clinical, laboratory, and outcome data were collected from the ICU and hospital pathology databases. The analysis included 96 patients with CAP, 19 of whom had an existing diagnosis of cancer. Patients with cancer had a longer median time interval between hospital and ICU admission (1 vs 2 days, p = 0.049). On admission to ICU, there were no differences in white cell count, C-reactive protein, clotting, renal function, liver function, heart rate, temperature, systolic blood pressure or oxygenation index between patients with or without cancer. However, patients with cancer had significantly lower haemoglobin levels (median 8.6 vs 10.0 g/dl, p = 0.010) and lowest diastolic blood pressure (median 40 vs 50 mmHg, p = 0.026), and higher sodium levels (median 142 vs 139 mmol/l), p = 0.020), APACHE II (median 25 vs 20, p = 0.009), SAPS II (median 51 vs 43, p = 0.039) and SOFA (median 12 vs 9, p = 0.018) scores. There were no statistically significant differences in the proportion of patients receiving mechanical ventilation or renal support, the duration of mechanical ventilation or ICU or hospital length of stay. Patients with cancer were more likely to receive vasopressors (89.5% vs 63.6%, p = 0.030) and had increased ICU (68.4% vs 31.2%, p = 0.004) and hospital (78.9% vs 33.8%, p = 0.001) mortality. The limitations of this study are its relatively small sample size and those associated with the retrospective study design. In conclusion, cancer patients with CAP had an increased risk of death that was associated with increased illness severity and prevalence of septic shock at the time of ICU admission, suggesting there may be a delay in recognition for the need for intensive care support in these patients.
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Affiliation(s)
- Ricardo J P José
- 110Centre for Inflammation and Tissue Repair, Department of Thoracic Medicine, University College London Hospital, 5 University Street, London, WC1E6JF UK.,210Department of Intensive Care Medicine, Royal Free Hospital, London, UK.,510Centre for Inflammation and Tissue Repair, University College London, London, UK
| | - Ali O Mohammed
- 210Department of Intensive Care Medicine, Royal Free Hospital, London, UK.,310Department of Thoracic Medicine, Minia University, Elminia, Egypt
| | | | - Rachel C Chambers
- 510Centre for Inflammation and Tissue Repair, University College London, London, UK
| | - Jeremy S Brown
- 110Centre for Inflammation and Tissue Repair, Department of Thoracic Medicine, University College London Hospital, 5 University Street, London, WC1E6JF UK.,510Centre for Inflammation and Tissue Repair, University College London, London, UK
| | - Banwari Agarwal
- 210Department of Intensive Care Medicine, Royal Free Hospital, London, UK
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