Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

BACKGROUND: This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU. METHODS AND RESULTS: Multivariate analysis of data fo...

Authors: Pohlen, Michéle Yvonne
Thoennißen, Nils Heinrich
Braess, Jan
Thudium, Johannes
Schmid, Christoph
Kochanek, Matthias
Kreuzer, Karl-Anton
Lebiedz, Pia
Görlich, Dennis
Gerth, Hans Ulrich
Rohde, Christian
Keßler, Torsten
Müller-Tidow, Carsten
Stelljes, Matthias
Büchner, Thomas
Schlimok, Günter
Hallek, Michael
Waltenberger, Johannes
Hiddemann, Wolfgang
Berdel, Wolfgang E.
Heilmeier, Bernhard
Krug, Utz
Division/Institute:FB 05: Medizinische Fakultät
Document types:Article
Media types:Text
Publication date:2016
Date of publication on miami:29.12.2016
Modification date:12.09.2019
Edition statement:[Electronic ed.]
Source:PLoS ONE 11 (2016) 8, e0160871, 1-16
DDC Subject:610: Medizin und Gesundheit
License:CC BY 4.0
Language:English
Notes:Finanziert durch den Open-Access-Publikationsfonds 2015/2016 der Westfälischen Wilhelms-Universität Münster (WWU Münster)
Format:PDF document
ISSN:1932-6203
URN:urn:nbn:de:hbz:6-83269517453
Permalink:http://nbn-resolving.de/urn:nbn:de:hbz:6-83269517453
Other Identifiers:DOI: 10.1371/journal.pone.0160871
Digital documents:journal.pone.0160871.PDF

BACKGROUND: This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU. METHODS AND RESULTS: Multivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operator characteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of ≥25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge. CONCLUSIONS: Our data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit from intensive care.