Details

Autor(en) / Beteiligte

• Slavin, Samuel D.
• Fenech, Alyssa
• Jankowski, Amanda L.
• Abel, Gregory A.
• Brunner, Andrew M.
• Steensma, David P.
• Fathi, Amir T.
• DeAngelo, Daniel J.
• Wadleigh, Martha
• Hobbs, Gabriela S.
• Amrein, Philip C.
• Stone, Richard M.
• Temel, Jennifer S.
• El‐Jawahri, Areej

Titel

Outcomes for older adults with acute myeloid leukemia after an intensive care unit admission

Ist Teil von

• Cancer, 2019-11, Vol.125 (21), p.3845-3852

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Background Older adults with acute myeloid leukemia (AML) are often assumed to have poor outcomes after admission to the intensive care unit (ICU). However, little is known about ICU utilization and post‐ICU outcomes in this population. Methods The authors conducted a retrospective analysis for 330 patients who were 60 years old or older and were diagnosed with AML between 2005 and 2013 at 2 hospitals in Boston.They used descriptive statistics to examine the proportion of patients admitted to the ICU as well as their mortality and functional recovery. They used logistic regression to identify risk factors for in‐hospital mortality. Results Ninety‐six patients (29%) were admitted to the ICU, primarily because of respiratory failure (39%), septic shock (28%), and neurological compromise (9%). The proportions of patients who survived to hospital discharge, 90 days, and 1 year were 47% (45 of 96), 35% (34 of 96), and 30% (29 of 96), respectively. At 90 days, 76% of the patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1, and 86% were in complete remission (CR) and/or continued to receive AML‐directed therapy. In a multivariate analysis, a poorer baseline ECOG PS score (odds ratio, 2.76; P = .013) and the need for 2 or more life‐sustaining therapies (ie, vasopressors, invasive ventilation, and/or renal replacement therapy; odds ratio, 12.4; P < .001) were associated with increased odds of in‐hospital mortality. Conclusions Although almost one‐third of older patients with AML are admitted to an ICU, nearly half survive to hospital discharge with good functional outcomes. The baseline performance status and the need for 2 or more life‐sustaining therapies predict hospital mortality. These data support the judicious use of ICU resources for older patients with AML. Older adults with acute myeloid leukemia experience high rates of intensive care unit (ICU) admission, and nearly half of those admitted to the ICU survive to hospital discharge with good functional outcomes. A poor performance status and the need for multiple life‐sustaining therapies are important predictors of ICU mortality.