Zübeyde Nur ÖZKURT, Zeynep Arzu YEGİN, Melda TÜRKOĞLU, Nazlıhan BOYACI DÜNDAR, Gülbin AYGENCEL, Abdullah Münci YAĞCI

Can treating critically-ill haematological malignancy patients in a separate intensive care unit decrease intensive care unit mortality?

Background/aim: The aim of the study was to investigate whether treating haematological malignancy (HM) patients in a separate intensive care unit (ICU) would reduce ICU mortality. Materials and methods: HM patients treated by the same ICU team in a general medical ICU (GM-ICU) and a separate haematology ICU (H-ICU) were included in this study. Patients’ demographic characteristics and ICU data were recorded retrospectively. Differences in the ICU course and prognosis between these two groups were determined. Results: A total of 251 patients (102 from GM-ICU, 149 from H-ICU) were included in this study. The disease severity and organ failure scores at ICU admission and underlying HMs were not different between the two groups. Patients waited longer for admission to GMICU. Therapeutic procedures were performed significantly more frequently in GM-ICU. ICU complications were not different between the groups. ICU mortality rates were higher in GM-ICU (59.8% vs 37.6%, p = 0.006). Conclusion: A separate ICU allocated for haematology patients will allow timely and rapid admission of HM patients to ICU. Thus, mortality rates of HM patients needing ICU care will decline.Key words: Intensive care unit, separate intensive care unit, patients with haematological malignancies, intensive care unit mortality

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1. Thiéry G, Azoulay E, Darmon M, Ciroldi M, De Miranda S et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. Journal of Clinical Oncology 2005; 23 (19): 4406-4413. doi: 10.1200/ JCO.2005.01.487
2. Aygencel G, Turkoglu M, Turkoz Sucak G, Benekli M. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. Journal of Critical Care 2014; 29 (4): 618-626. doi:10.1016/j.jcrc.2014.01.014
3. Soares M, Caruso P, Silva E, Teles JM, Lobo SM et al. Brazilian Research in Intensive Care Network (BRICNet). Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Critical Care Medicine 2010; 38 (1): 9-15. doi: 10.1097/ CCM.0b013e3181c0349e
4. Cherif H, Martling CR, Hansen J, Kalin M, Björkholm M. Predictors of short and long-term outcome in patients with hematological disorders admitted to the intensive care unit for a life-threatening complication. Supportive Care in Cancer
2007; 15 (12): 1393-1398. doi: 10.1007/s00520-007-0268-1 5. Namendys-Silva SA, González-Herrera MO, García-Guillén FJ, Texcocano-Becerra J, Herrera-Gómez A. Outcome of critically ill patients with hematological malignancies. Annals of Hematology 2013; 92 (5): 699-705. doi: 10.1007/s00277-013- 1675-7
6. Magid T, Haase N, Andersen JS, Nielsen OJ, Bonde J. Intensive care of haematological patients. Danish Medical Journal 2012; 59 (3): A4395. PMID: 22381090
7. 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. British Journal of Anaesthesia 2012; 108 (3): 452-459. doi: 10.1093/bja/aer449
8. Kalicińska, E, Kuszczak, B, Dębski J, Szukalski L, Wątek M et al. Hematological malignancies in Polish population: what are the predictors of outcome in patients admitted to Intensive Care Unit? Supportive Care in Cancer 2021; 29: 323-330. doi: 10.1007/s00520-020-05480-3
9. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y et al. Characteristics and outcomes of cancer patients in European ICUs. Critical Care 2009; 13 (1): R15. doi: 10.1186/cc7713
10. Gordon AC, Oakervee HE, Kaya B, Thomas JM, Barnett MJ et al. Incidence and outcome of critical illness amongst hospitalised patients with haematological malignancy: a prospective observational study of ward and intensive care unit based care. Anaesthesia 2005; 60 (4): 340-347. doi: 10.1111/j.1365-2044.2005.04139.x
11. Hampshire PA, Welch CA, McCrossan LA, Francis K, Harrison DA. Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2009; 13 (4): R137. doi: 10.1186/cc8016
12. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. Journal of Clinical Oncology 2013; 31 (22): 2810-2818. doi: 10.1200/JCO.2012. 47.2365
13. Azoulay E, Pène F, Darmon M, Lengliné E, Benoit D et al. Groupe de Recherche Respiratoire en Réanimation OncoHématologique (Grrr-OH). Managing critically ill hematology patients: Time to think differently. Blood Reviews 2015; 29 (6): 359-367. doi: 10.1016/j.blre.2015.04.002
14. Hill QA, Kelly RJ, Patalappa C, Whittle AM, Scally AJ 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. Leukemia & Lymphoma. 2012; 53 (2): 282-288. doi: 10.3109/10428194. 2011.614705
15. Yeo CD, Kim JW, Kim SC, Kim YK, Kim KH et al. Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. Journal of Critical Care 2012; 27 (6): 739.e1-6. doi: 10.1016/j.jcrc.2012.07.014
16. Ferrà C, Marcos P, Misis M, Morgades M, Bordejé ML et al. Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: a singlecenter experience. International Journal of Hematology 2007; 85 (3): 195-202. doi: 10.1532/IJH97.E0625
17. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Critical Care Medicine 2003; 31 (1): 104-112. doi: 10.1097/00003246- 200301000-00017
18. Al-Zubaidi N, Shehada E, Alshabani K, ZazaDitYafawi J, Kingah P et al. Predictors of outcome in patients with hematologic malignancies admitted to the intensive care unit. Hematology/Oncology and Stem Cell Therapy 2018; 11 (4): 206-218. doi: 10.1016/j.hemonc.2018.03.003
19. Hampshire PA, Pugh R, Hajimichael P. Outcomes for critically ill patients with haematological malignancies in specialist and non-specialist centres in the United Kingdom. Journal of Cancer Therapeutics & Research 2014; 3: 5. doi: 10.7243/2049- 7962-3-5
20. Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O’Brien CR et al. Hospital volume and the outcomes of mechanical ventilation. New England Journal of Medicine 2006; 355 (1): 41-50. doi: 10.1056/NEJMsa053993
21. Shahin J, Harrison DA, Rowan KM. Is the volume of mechanically ventilated admissions to UK critical care units associated with improved outcomes? Intensive Care Medicine 2014; 40 (3): 353-360. doi: 10.1007/s00134-013-3205-4
22. Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P et al. Case volume and mortality in haematological patients with acute respiratory failure. European Respiratory Journal 2008; 32 (3): 748-754. doi: 10.1183/09031936.00142907