[Results of intensive care treatment in patients with hematologic malignancies; relation to infections]

In a retrospective study we determined the factors that influence the outcome of patients requiring intensive care (IC) for the complications of the treatment of haematological malignancies. All consecutive patients suffering from haematological malignancy admitted to the IC unit of the University Hospital Nijmegen over a 4 year period (1986-1989) were studied; 39 patients (21 female, 18 male) with a median age of 41 year (range 18-71). Various clinical variables were assessed at admission and related to the outcome of IC treatment in terms of death or survival. Previously, 33 patients had undergone chemotherapy. Eight (21%) survived. One of a subgroup of 13 bone marrow transplantation patients survived. Hypoxaemic respiratory failure requiring mechanical ventilation was the most frequent reason for admission (20 patients of whom four recovered). The second most frequent reason was combination of respiratory failure and septic shock (eight patients, none recovered). Three out of five patients admitted with septic shock survived. The need for mechanical ventilation had the highest predictive power for a poor prognosis (p = 0.002). Mortality increased with increasing APACHE II score (p = 0.03). When more than four major organ systems were affected (seven patients), mortality was 100%. Granulocytopenia (leucocyte count less than 1 x 10(9)/l) at admission turned out to be of no prognostic significance, but absence of leucocyte recovery was a prognostically bad sign (p = 0.05). A considerable number of patients (20) suffered from a non-bacterial (opportunistic) infection, carrying a high mortality (only two patients survived: one with candida, one with a cytomegalovirus infection).(ABSTRACT TRUNCATED AT 250 WORDS)