Characteristics and short-term outcomes of patients with hematological malignancies admitted to Intensive care units: a retrospective cohort study using the Japanese Intensive care PAtient Database

Abstract

Background: The aim of this study was to assess in-hospital mortality and identify its predictors in adult patients with hematological malignancies admitted to intensive care units (ICUs) in Japan.

Methods: We conducted a retrospective cohort study of adult patients with hematological malignancies admitted to ICUs participating in the Japanese Intensive care PAtient Database from 2015 to 2020. The primary outcome was in-hospital mortality. We compared survivors and non-survivors based on their characteristics at ICU admission and ICU treatments. We also assessed the relationship between institutional characteristics and in-hospital mortality.

Results: A total of 1,700 patients from 69 institutions were included. In-hospital mortality was 46.2%. The most common reason for ICU admission was respiratory failure (28.2%). Mechanical ventilation and continuous renal replacement therapy were used in 49.0% and 24.6% of patients, respectively. In multivariable logistic regression analysis, a higher in-hospital mortality was independently associated with type of neoplasm, Acute Physiological Assessment and Chronic Health Evaluation III score, invasive mechanical ventilation (OR 1.64, 95% CI 1.30-2.08), noninvasive ventilation (OR 1.71, 95% CI 1.22-2.41), and continuous renal replacement therapy (OR 1.98, 95% CI 1.51-2.61), whereas other patient characteristics (e.g., age, comorbidities, ICU admission source, reason for ICU admission) were not associated. There was also no association between institutional characteristics and in-hospital mortality.

Conclusions: In-hospital mortality of adult patients with hematological malignancies admitted to ICUs remains high. Factors associated with in-hospital mortality in these patients differed from those in the general ICU population. Institutional characteristics were not significantly associated with in-hospital mortality.

Keywords: Hematologic neoplasms; Institutional effect; Intensive care unit; Predictors; Short-term mortality.