PROGNOSTIC FACTORS FOR NEUTROPENIC PATIENTS IN AN INTENSIVE-CARE UNIT- RESPECTIVE ROLES OF UNDERLYING MALIGNANCIES AND ACUTE ORGAN FAILURES

The admission of neutropenic patients to an intensive care unit (ICU) is still controversial, especially if mechanical ventilation is requir ed. To avoid useless stays in ICU, the evaluation of the respective ro le of the underlying malignancy and acute organ failures might be usef ul for better definition of the categories of patients who could benef it from aggressive ICU support. For this purpose, we carried out a ret rospective study of the charts of 107 consecutive neutropenic patients admitted to an ICU in a comprehensive cancer centre over a four-year period. The following characteristics were recorded within 24 h of adm ission: patient data, characteristics of neutropenia and the underlyin g malignancy, the type and number of organ system failures (OSFs) and simplified acute physiological scores (SAPS and SAPS II). The impact o f each variable on outcome in the ICU was studied by univariate and mu ltivariate (logistic regression) analysis. 59 patients died in the ICU (mortality rate: 55%). Patients with a haematological malignancy (n = 57, 53%) were more likely to experience respiratory failure, an under lying malignancy deemed rapidly fatal, and to have longer lasting neut ropenia than patients with a solid tumour (n = 50, 47%). However, the mortality rate did not differ in the two groups (haematological malign ancy 61% versus solid tumour 48%, p = 0.16). Respiratory and cardiovas cular organ failure (p < 0.001 for both) correlated with mortality in the ICU. In the multiple logistic regression model, only the number of organ system failures and respiratory failure remained predictive of ICU mortality. In conclusion, the characteristics of the underlying ma lignancy are not relevant when deciding whether or not neutropenic pat ients should be admitted to an ICU. The main risk factors for death in an ICU are the number of organ failures on admission, and among them the presence of respiratory failure. (C) 1997 Elsevier Science Ltd.