Purpose

To describe the modern incidence and predictors of ICU admission for adult patients newly diagnosed with a hematologic malignancy.

Methods

We conducted a population-based cohort study of adults with a new diagnosis of hematologic malignancy (April 1, 2006–March 31, 2017) in Ontario, Canada. We described the baseline demographic, clinical and laboratory predictors of ICU admission and subsequent mortality. The primary outcome was the incidence of ICU admission within 1 year of hematologic malignancy diagnosis. We assessed the predictors of ICU admission using Cox-proportional models that accounted for the competing risk of death and reported as subdistribution hazard ratios (sHR) with 95% confidence intervals (CI).

Results

A total of 87,965 patients (mean [SD] age, 67.8 (15.7) years) were included. The 1-year incidence of ICU admission was 13.9% (median time 35 days), ranging from 7.3% (indolent lymphoma) to 22.5% (acute myeloid leukemia). After multivariable adjustment, compared to indolent lymphoma, acute myeloid leukemia (sHR, 3.09; 95% CI 2.84–3.35), aggressive non-Hodgkin lymphoma (sHR, 2.47; 95% CI 2.31–2.65) and acute lymphoblastic leukemia (sHR, 2.46; 95% CI 2.15–2.80) had the highest risk of ICU admission. Comorbidities such as cardiovascular disease (sHR, 2.09; 95% CI 2.01–2.19), chronic obstructive pulmonary disease (sHR, 1.33; 95% CI 1.26–1.39) and baseline laboratory abnormalities (anemia, thrombocytopenia and high creatinine) were also associated with ICU admission. Among ICU patients, 36.7% required invasive mechanical ventilation and in-hospital mortality was 31%.

Conclusion

Critical illness in patients with a newly diagnosed hematologic malignancy is frequent, occurring early after diagnosis. Certain baseline characteristics can help identify those patients at the highest risk.

中文翻译：

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血液系统恶性肿瘤患者的危重疾病：一项基于人群的队列研究

目的

描述新诊断为血液系统恶性肿瘤的成年患者入住 ICU 的现代发病率和预测因素。

方法

我们对加拿大安大略省新诊断为血液系统恶性肿瘤的成年人（2006 年 4 月 1 日至 2017 年 3 月 31 日）进行了一项基于人群的队列研究。我们描述了入住 ICU 和随后死亡率的基线人口统计学、临床和实验室预测因素。主要结果是血液系统恶性肿瘤诊断后 1 年内入住 ICU 的发生率。我们使用 Cox 比例模型评估了入住 ICU 的预测因素，该模型考虑了死亡的竞争风险，并报告为具有 95% 置信区间 (CI) 的亚分布风险比 (sHR)。

结果

总共包括 87,965 名患者（平均 [SD] 年龄，67.8 (15.7) 岁）。ICU 入院的 1 年发生率为 13.9%（中位时间 35 天），范围从 7.3%（惰性淋巴瘤）到 22.5%（急性髓系白血病）。多变量调整后，与惰性淋巴瘤、急性髓系白血病（sHR，3.09；95% CI 2.84-3.35）、侵袭性非霍奇金淋巴瘤（sHR，2.47；95% CI 2.31-2.65）和急性淋巴细胞白血病（sHR，2.46）相比; 95% CI 2.15–2.80) 入住 ICU 的风险最高。心血管疾病（sHR，2.09；95% CI 2.01–2.19）、慢性阻塞性肺疾病（sHR，1.33；95% CI 1.26–1.39）和基线实验室异常（贫血、血小板减少和肌酐高）等合并症也与入住ICU。在ICU患者中，36。

结论

新诊断的血液系统恶性肿瘤患者的危重病很常见，发生在诊断后的早期。某些基线特征可以帮助识别那些风险最高的患者。