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Survival of hematological patients after discharge from the intensive care unit: a prospective observational study

Teresa Bernal12*, Estefanía V Pardavila1, Juan Bonastre3, Isidro Jarque4, Marcio Borges5, Joan Bargay6, Jose Ignacio Ayestarán7, Josu Insausti8, Pilar Marcos9, Victor González-Sanz10, Pablo Martínez-Camblor11 and Guillermo M Albaiceta121314

Author Affiliations

1 Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Celestino Villamil s/n., 33006 Oviedo, Spain

2 Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain

3 Servicio de Medicina Intensiva, Hospital Universitario La Fe, Valencia, Spain

4 Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain

5 Servicio de Medicina Intensiva, Hospital Son Llatzer, Palma de Mallorca, Spain

6 Servicio de Hematología, Hospital Son Llatzer, Palma de Mallorca, Spain

7 Servicio de Medicina Intensiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain

8 Servicio de Medicina Intensiva, Hospital de Navarra, Pamplona, Spain

9 Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Spain

10 Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain

11 Oficina de Investigación Biosanitaria-FICYT, Oviedo, Spain

12 Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain

13 CIBER-Enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain

14 Departamento de Biología Funcional, Área de Fisiología, IUOPA, Universidad de Oviedo, Oviedo, Spain

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Critical Care 2013, 17:R302  doi:10.1186/cc13172

Published: 30 December 2013

Abstract

Introduction

Although the survival rates of hematological patients admitted to the ICU are improving, little is known about the long-term outcome. Our objective was to identify factors related to long-term outcome in hematological patients after ICU discharge.

Methods

A prospective, observational study was carried out in seven centers in Spain. From an initial sample of 161 hematological patients admitted to one of the participating ICUs during the study period, 62 were discharged alive and followed for a median time of 23 (1 to 54) months. Univariate and multivariate analysis were performed to identify the factors related to long term-survival. Finally, variables that influence the continuation of the scheduled therapy for the hematological disease were studied.

Results

Mortality after ICU discharge was 61%, with a median survival of 18 (1 to 54) months. In the multivariate analysis, an Eastern Cooperative Oncology Group score (ECOG) >2 at ICU discharge (Hazard ratio 11.15 (4.626 to 26.872)), relapse of the hematological disease (Hazard ratio 9.738 (3.804 to 24.93)) and discontinuation of the planned treatment for the hematological disease (Hazard ratio 4.349 (1.286 to 14.705)) were independently related to mortality. Absence of stem cell transplantation, high ECOG and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores decreased the probability of receiving the planned therapy for the hematological malignancy.

Conclusions

Both ICU care and post-ICU management determine the long-term outcome of hematological patients who are discharged alive from the ICU.