Hematolojik kanser tanısıyla yoğun bakım ünitesinde takip edilen hastaların klinik özelliklerinin ve sonuçlarının değerlendirilmesi: tek merkez deneyimi

Giriş: Hematolojik kanser (HK) tanısı alan hastaların takip ve tedavisi sırasında sıklıkla yoğun bakım ihtiyacı olmaktadır. Bu çalışma ile yoğun bakım ünitesinde (YBÜ) takip edilen HK tanısı almış hastaların, klinik özellikleri ve takip sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Bu çalışmada, Şubat 2019 ile Mart 2020 tarihleri arasında yoğun bakım takibi gerektiren 77 erişkin hastanın kayıtları geriye dönük olarak incelenmiştir. Bulgular: Çalışmaya alınan, 38 (%50,6) hasta nötropenikti ve YBÜ'ne yatış sırasında 67 hastada (%87) enfeksiyon vardı. 35 (%45,5) hastaya akut miyeloid lösemi tanısı konmuştu. 56 (%72,7) hastaya yatışta mekanik ventilasyon uygulanmıştı. İzlemde 32 (%41,6) hastada YBÜ enfeksiyonu, 24 (%31,2) hastada bakteriyemi gelişmiş olup en sık saptanan patojenler; gram-negatif basillerden Klebsiella pneumonia (n=11, %14,3) ve fermentasyon yapmayan bakterilerdi (n=13, %16,6). Genel YBÜ sağ kalım oranı %32,5 (n:25) idi. Tek değişkenli analizde mortaliteyi etkilediği ön görülen değişkenler; APACHE II skoru ≥ 25 (p<0,001), kanser tedavisine direnç veya relaps (p=0.015), yatışta septik şok (p<0.001), invaziv mekanik ventilasyon ihtiyacı (p<0,001) ve hastane enfeksiyon varlığı (p=0,006) istatistiksel olarak anlamlı risk faktörleri olarak saptandı. Bu değişkenler ile kurulan çok değişkenli model sonucunda ise APACHE II skorunun mortalite için anlamlı bir tahmin edici olduğu görüldü (ROC:0.884) . Sonuç: APACHE II skoru≥25 ve septik şok önemli kötü prognoz kriterleridir. Yoğun bakım ihtiyacı olan HK hastalarının takip ve tedavisinde belirlenecek protokoller, destekleyici tedaviler ve hastane enfeksiyonlarının önlenmesi ile tedavi başarısının ve yaşam süresinin uzatılması sağlanabilir.

Anahtar Kelimeler:

yoğun bakım ünitesi, hematolojik kanser, enfeksiyon

Evaluation of clinical features and results of patients followed up in the intensive care unit with the diagnosis of hematological cancer: a single center experience

Introduction: Patients diagnosed with hematological cancer (HC) often need intensive care during their follow-up and treatment. In this study, it was aimed to evaluate the clinical characteristics and follow-up results of patients diagnosed with HC who were followed up in the intensive care unit (ICU). Materials and methods: This is a retrospective study enrolling 77 adult HC patients requiring intensive care between February 2019 and March, 2020. Results: Thirty-eight (50.6%) patients included in the study were neutropenic and 67 patients (87%) had infection during admission to the ICU. Acute myeloid leukemia was diagnosed in 35 (45.5%) patients. Mechanical ventilation was applied to 56 (72.7%) patients on admission. In the follow-up, 32 (41.6%) patients developed ICU infection, 24 (31.2%) patients developed bacteremia. The most common pathogens were; Klebsiella pneumonia (n = 11, 14.3%) and non-fermentation bacteria (n = 13, 16.6%) were gram-negative bacilli. Overall ICU survival rate was 32.5% (n: 25). Variables predicted to affect mortality in univariate analysis; APACHE II score ≥ 25 (p <0.001), resistance to cancer treatment or relapse (p = 0.015), septic shock at hospitalization (p <0.001), need for invasive mechanical ventilation (p <0.001) and presence of hospital infection (p = 0.006) were statistically were found to be significant risk factors. As a result of the multivariate model established with these variables, it was seen that the APACHE II score was a significant predictor for mortality (ROC: 0.884). Conclusion: APACHE II score 25 and septic shock are important poor prognosis criteria. Successful treatment and long survival can be achieved by the protocols to be determined in the follow-up and treatment of HC patients in need of intensive care, supportive treatments and prevention of nosocomial infections.

Keywords:

intensive care unit, hematological cancer, infection,

PDF

___

Vijenthira A, Chiu N, Jacobson D, et al. Predictors of intensive care unit admission in patients with hematologic malignancy. Sci Rep 2020;10:21145. https://doi.org/10.1038/s41598-020-78114-7
Cornish M, Butler MB, Green RS. Predictors of poor outcomes in critically Ill adults with hematologic malignancy. Can Respir J 2016;2016:9431385. https://doi.org/10.1155/2016/9431385
Hill QA, Kelly RJ, Patalappa C, et al. Survival of patients with hematological malignancy admitted to the intensive care unit: prognostic factors and outcome compared to unselected medical intensive care unit admissions, a parallel group study. Leuk Lymphoma. 2012;53:282-288. https://doi.org/10.3109/10428194.2011.614705
Bird GT, Farquhar Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth 2012;108:452-459. https://doi.org/10.1093/bja/aer449
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801–10. https://doi.org/10.1001/jama.2016.0287
Yoo H, Suh GY, Jeong BH, Lim SY, Chung MP, Kwon OJ, et al. Etiologies, diagnostic strategies, and outcomes of diffuse pulmonary infiltrates causing acute respiratory failure in cancer patients: a retrospective observational study. CritCare 2013;17(4):R150. https://doi.org/10.1186/cc12829.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. https://doi.org/10.1001/jama.2012.5669.
KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:c179–84. https://doi.org/10.1159/000339789
Escobar K, Rojas P, Ernst D, et al. Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Católica de Chile Hospital. Biol Blood Marrow Transplant 2015;21:176-179. https://doi.org/10.1016/j.bbmt.2014.08.009
Parakh S, Piggin A, Neeman T, Mitchell I, Crispin P, Davis A. Outcomes of haematology/oncology patients admitted to intensive care unit at The Canberra Hospital. Intern Med J 2014;44:1087-1094. https://doi.org/10.1111/imj.12545
McGrath S, Chatterjee F, Whiteley C, Ostermann M. ICU and 6-month outcome of oncology patients in the intensive care unit. QJM 2010;103:397-403. https://doi.org/10.1093/qjmed/hcq032
Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 2007;35:808-814. https://doi.org/10.1097/01.CCM.0000256846.27192.7A
Geerse DA, Span LF, Pinto Sietsma SJ, van Mook WN. Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality. Eur J Intern Med 2011;22:57-61. https://doi.org/10.1016/j.ejim.2010.11.003
Aygencel G, Turkoglu M, Turkoz Sucak G, Benekli M. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care 2014;29:618-626. https://doi.org/10.1016/j.jcrc.2014.01.014
McGrath S, Chatterjee F, Whiteley C, Ostermann M. ICU and 6-month outcome of oncology patients in the intensive care unit. QJM. 2010;103:397-403. https://doi.org/10.1093/qjmed/hcq032
Malak S, Sotto JJ, Ceccaldi J, et al. Ethical and clinical aspects of intensive care unit admission in patients with hematological malignancies: guidelines of the ethics commission of the French society of hematology. Adv Hematol 2014;2014:704318. https://doi.org/10.1155/2014/704318
Thom KA, Kleinberg M, Roghmann MC. Infection prevention in the cancer center. Clin Infect Dis 2013;57:579-585. https://doi.org/10.1093/cid/cit290
Huoi C, Vanhems P, Nicolle MC, Michallet M, Bénet T. Incidence of hospital-acquired pneumonia, bacteraemia and urinary tract infections in patients with haematological malignancies, 2004-2010: a surveillance-based study. PLoS One. 2013;8:e58121. https://doi.org/10.1371/journal.pone.0058121
Cornejo Juárez P, Vilar Compte D, Pérez Jiménez C, Ñamendys Silva SA, Sandoval Hernández S, Volkow Fernández P. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit. Int J Infect Dis 2015;31:31-34. https://doi.org/10.1016/j.ijid.2014.12.022