Dominique M. Vandijck Pieter O. Depuydt Fritz C. Offner Joke Nollet Renaat A. Peleman Eva Steel Lucien A. Noens Johan M. Decruyenaere Dominique D. Benoit Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies Received: 3 June 2009 Accepted: 7 April 2010 Published online: 18 May 2010 Ó Copyright jointly held by Springer and ESICM 2010 Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-1903-8) contains supplementary material, which is available to authorized users. D. M. Vandijck ( ) ) Department of Public Health and Health Economics, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium e-mail: Dominique.Vandijck@UGent.be Tel.: ?32-9-3325047 Fax: ?32-9-3323862 D. M. Vandijck Á R. A. Peleman Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium P. O. Depuydt Á J. Nollet Á J. M. Decruyenaere Á D. D. Benoit Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium F. C. Offner Á E. Steel Á L. A. Noens Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Abstract Purpose: To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality. Methods: Retrospective analysis of prospectively collected data was performed. Sequential Organ Failure Assessment (SOFA) scores from day 1 to 5 were calculated in all consec- utive hematologic malignancy patients admitted to the ICU (2000– 2006). Patients were categorized according to the presence or absence, the diagnostic certainty, and the site of BI. Results: Of the 344 patients admitted, 258 were still in the ICU at day 3 and 164 at day 5. Patients admitted because of BI had more severe OD on day 1 (SOFA 9.7 ± 4.0 vs. 8.4 ± 4.0, p = 0.008) but a more rapidly reversible OD within the first 3 days (DSOFA -1.12 ± 3.10 vs. 0.03 ± 3.40, p = 0.013) and a lower in-hospital (43.2% vs. 62.9%, p \ 0.001) and 6-month mortality (52.1% vs. 71.7%, p \ 0.001) than patients with other complications. In a multivariate analysis, BI remained associated with a lower risk of death (OR 0.20, 95% CI 0.1–0.4, p \ 0.001) even after adjustment for the SOFA on day 1 (OR 1.36, 95% CI 1.22–1.52, p \ 0.001) and the DSOFA (OR 1.48, 95% CI 1.29–1.68, p \ 0.001). These findings remained significant regardless of the site and the diagnostic certainty of BI. Con- clusion: BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other compli- cations in ICU patients with hematologic malignancies. These findings further support the recom- mendation that these patients should certainly benefit from advanced life support, and in the case of an uncer- tain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial. Keywords Admission diagnosis Á Critically ill Á Evolution Á Hematologic malignancy Á Outcome Á Sequential Organ Failure Assessment score Intensive Care Med (2010) 36:1744–1750 DOI 10.1007/s00134-010-1903-8 ORIGINAL