Critical illness in patients with hematologic malignancy: a population-based cohort study

Area of Science:

• Hematology
• Critical Care Medicine
• Epidemiology

Background:

• Hematologic malignancies are a significant cause of critical illness in adults.
• Understanding the incidence and predictors of intensive care unit (ICU) admission is crucial for resource allocation and patient management.

Purpose of the Study:

• To determine the modern incidence of ICU admission among adult patients with a new hematologic malignancy diagnosis.
• To identify baseline demographic, clinical, and laboratory predictors associated with ICU admission and mortality in this population.

Main Methods:

• A population-based cohort study was conducted in Ontario, Canada, including adults diagnosed with hematologic malignancy between April 1, 2006, and March 31, 2017.
• Cox-proportional models, accounting for competing risks of death, were used to assess predictors of ICU admission, reporting subdistribution hazard ratios (sHR) and 95% confidence intervals (CI).

Main Results:

• The 1-year incidence of ICU admission was 13.9%, with significant variation by malignancy type (e.g., 7.3% for indolent lymphoma to 22.5% for acute myeloid leukemia).
• Higher risks of ICU admission were associated with acute myeloid leukemia, aggressive non-Hodgkin lymphoma, and acute lymphoblastic leukemia. Comorbidities like cardiovascular disease, COPD, and baseline laboratory abnormalities also increased risk.
• Among ICU admissions, 36.7% required invasive mechanical ventilation, and in-hospital mortality was 31%.

Conclusions:

• Critical illness requiring ICU admission is a frequent early complication for patients with newly diagnosed hematologic malignancies.
• Identifying patients at higher risk based on baseline characteristics is possible and can inform clinical decision-making and prognostication.