Determinants of 6-month survival of critically ill patients with an active hematologic malignancy ☆,☆☆ Stephen Richards, MBBCh, BSc, FCICM a, ⁎, Bradley Wibrow, FACEM, FCICM, MBBS a , Matthew Anstey, MBBS, MPH, FACEM, FCICM a , Hasib Sidiqi, MBBS a , Ashlyn Chee, MBBS b , Kwok M. Ho, MBBS, MPH, MRCP, FANZCA, FJFICM, PhD b a Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6009, Australia b Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia 6847, Australia abstract article info Available online xxxx Keywords: Hematologic malignancy Intensive care Critical care Purpose: This study assessed the determinants of 6-month survival of critically ill patients with an active hematologic malignancy (HM). Methods: All patients with an active HM defined by either receiving ongoing or due to receive antineoplastic therapy, admitted to 2 tertiary intensive care units between 2010 and 2015, were included in this retrospective cohort study. Results: Of the 273 patients included in the study (median age, 63 [interquartile range, 54-71] years; 40.7% female), 116 (42.5%; 95% confidence interval, 36.8-48.4) died in hospital. The 6-month mortality was 56.4% (95% confidence interval, 50.5-62.2). Mechanical ventilation, intensive care unit admission source, and the type of active HM were significantly associated with hospital mortality and 6-month survival, after adjusting for severity of acute illness. The type of active HM was the most important prognostic factor, with over a 10-fold difference in 6-month survival between HM with the best and worst prognosis. In addition, recent hematopoietic stem cell transplant (b30 days) was associated with a better 6-month survival. Conclusion: Differences in 6-month survival between critically ill patients with different types of active HM were substantial. Recent hematopoietic stem cell transplant, severity of illness, and use of mechanical ventilation were additional important determinants of 6-month survival in patients with an active HM. © 2016 Elsevier Inc. All rights reserved. 1. Introduction Patients with hematologic malignancies (HMs) are at increased risk of critical illness [1]. Organ failure may result from the malignancy itself or direct and indirect effects of antineoplastic (chemotherapeutic and immunomodulatory) agents administered [1-4]. Outcomes of patients with HMs admitted to intensive care units (ICU) over the last 2 decades have demonstrated steady improvement [5-9]. These improvements have been attributed to advances in chemotherapy and immunomodu- latory therapy [1,7,8,10], diagnostic capabilities [7,11], and critical care treatments [1,8,11]. As such, there is an increasing recognition of the role of critical care for patients with HMs and how it can contribute toward improved outcomes [5,8,9,12] including quality of life [6], when critical illness occurs. Although independent prognostic factors for critically ill patients with HMs have been reported previously, these studies are limited by their small sample sizes [1,3,5,8,13,14], pooling patients with other solid organ malignancies [8,13,15], or a lack of survival information beyond hospital or early discharge [1,14,15]. More importantly, much of the current data on critically ill patients with HMs were derived from critically ill patients with possible inactive disease or HMs in remission [1,5,6,14]. It is possible that the prognosis of critically ill patients with active HMs is different from a broader group which in- cludes patients with a HM not requiring therapy or those in remission. Acute respiratory failure in patients with HMs requiring invasive mechanical ventilation (IMV) carries a poor prognosis [1,2,16-19]. Recent data suggest that this poor prognosis persists despite use of pro- tective lung ventilation strategies and overall improvement in mortality among all critically ill patients with HMs [1,5,14]. Reliable up-to-date observational data describing prognostic factors for critically ill patients with active HMs may assist patients and their families to have a realistic expectation of the likely outcomes after critical illness, improve communication, medical decision making, and Journal of Critical Care xxx (2016) xxx–xxx ☆ Funding: Departmental funds were used for sponsorship. ☆☆ Conflict of interest: KMH is funded by the WA Health and Raine Medical Research Foundation through the Raine Clinical Research Fellowship. The other authors declare no other conflict of interest. ⁎ Corresponding author. Tel.: +61 8 6457 1010; fax: +61 8 6457 4431. E-mail addresses: Stephen.Richards@health.wa.gov.au (S. Richards), Bradley.Wibrow@health.wa.gov.au (B. Wibrow), Matthew.Anstey@health.wa.gov.au (M. Anstey), Hasib.Sidiqi@health.wa.gov.au (H. Sidiqi), Ashlyn.Chee@health.wa.gov.au (A. Chee), Kwok.Ho@health.wa.gov.au (K.M. Ho). http://dx.doi.org/10.1016/j.jcrc.2016.08.022 0883-9441/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Critical Care journal homepage: www.jccjournal.org Please cite this article as: Richards S, et al, Determinants of 6-month survival of critically ill patients with an active hematologic malignancy, J Crit Care (2016), http://dx.doi.org/10.1016/j.jcrc.2016.08.022