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

Journal: Intensive care medicine

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Affiliated Institutions:  Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, University Avenue, Toronto, ON, MG X, Canada. Laveena.munshi@sinaihealth.ca. Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM U-HP, Grenoble, France. Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada. Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, Mount Sinai Hospital, University of Toronto, University Avenue, Toronto, ON, MG X, Canada. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Department of Medicine at Queen's University, Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada. Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. Department of Medicine, Royal Victoria Hospital, The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada. Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada. Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada. Division of Critical Care MedicineDepartment of Medicine at Hopital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.

Abstract summary 

Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described.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.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.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.

Authors & Co-authors:  Munshi Dumas Rochwerg Shoukat Detsky Fergusson Ferreyro Heffernan Herridge Magder Minden Patel Qureshi Schimmer Thyagu Wang Mehta

Study Outcome 

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Statistics
Citations :  Ferreyro BL, Scales DC, Wunsch H, Cheung MC, Gupta V, Saskin R, Thyagu S, Munshi L (2021) Critical illness in patients with hematologic malignancy: a population-based cohort study. Intensive Care Med 47(10):1104–1114
Authors :  17
Identifiers
Doi : 10.1007/s00134-024-07349-z
SSN : 1432-1238
Study Population
Male,Female
Mesh Terms
Other Terms
Hematologic malignancy;Immunocompromised;Long-term outcomes
Study Design
Study Approach
Country of Study
Mali
Publication Country
United States