F. Blot et al., PROGNOSTIC FACTORS FOR NEUTROPENIC PATIENTS IN AN INTENSIVE-CARE UNIT- RESPECTIVE ROLES OF UNDERLYING MALIGNANCIES AND ACUTE ORGAN FAILURES, European journal of cancer, 33(7), 1997, pp. 1031-1037
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.