Mortality association factors in hematologic cancer patients requiring mechanical ventilation for more than one day in a developing country. A prospective cohort study

Abstract

Background: The potential benefit of intensive care unit (ICU) admission of hematologic cancer patient requiring mechanical ventilation (MV) still controversial especially with increased cost of needed life support measures. Objective: To seek clinical predictors of ICU mortality in hematologic cancer patients requiring (MV) during the first day of admission to the ICU. Design, Setting, Participants: 448 patients were included in this prospective observational cohort study, between May 2014 and May 2016 at the oncology center of Mansoura university hospital. Measurements and Main Results: ICU mortality was (350 out of 448 patients). Indications of (MV) were sepsis (42%), airway/ pulmonary invasion by tumor (33%), cardiopulmonary arrest (3%), coma (16%) and pulmonary embolism (5%). The independent risk factors for mortality were performance status 3–4(odds ratio, 2.49; 95% confidence interval [1.35:4.60]); cancer recurrence/ progression (odds ratio, 9.31;95% confidence interval, [4.18:21.24]); pao2/ fio2 ratio < 150 (odds ratio, 2.47; 95% confidence interval, [1.344:4.68]); airway/ pulmonary involvement by tumor as a cause of M.V. (odds ratio, 6.73; 95% confidence interval, [2.2:10.05]); sequential organ failure assessment score(excluding respiratory points, each 4 points; odds ratio 2.14; 95% confidence interval, [1.16:3.133]); use of vasopressors (odds ratio, 3.39; confidence interval, [1.73:6.44]). Conclusion: Poor performance status, cancer status, severity of acute organ failure, use of vasopressors and airway/pulmonary involvement by tumor were the main predictors of mortality. Making use of such clinical data may help to provide intensive care for patients with a potential chance of survival.

Keywords

• Intensive care
• Hematological malignancy
• Acute respiratory failure
• Prognosis
• Mechanical ventilation