Dynamic changes in mortality risk factors for acute leukemia patients in the ICU and Post-ICU periods

Acute leukemia (AL) is an aggressive hematologic malignancy that often causes serious complications and requires intensive care unit (ICU) treatment. Identifying risk factors for mortality in AL patients during and post-ICU admission can improve prognosis. This retrospective study enrolled AL patients first admitted to the ICU of the Third Xiangya Hospital, Central South University, from November 2008 to October 2023. It analyzed risk factors associated with ICU mortality, 1-month mortality and 6-month mortality, and conducted a subgroup analysis of the prognosis of ICU survivors. A total of 126 patients were included in this study, with a median age of 42 years. Acute respiratory failure (46%) and sepsis (23%) were the main reasons for ICU admission. Overall, the mortality rates were 57.9% in the ICU, 67.5% at 1 month, and 69% at 6 months. Notably, among the ICU survivors, 26.4% (14/53) died within 6 months, with 85.7% (12/14) occurring within the first month. The time from hospital admission to ICU transfer >10 days and invasive mechanical ventilation were independent risk factors for ICU mortality, 1-month mortality and 6-month mortality. Relapsed or refractory leukemia (OR = 20.715) and low albumin levels (OR = 34.428) were independent risk factors for death within one month among ICU survivors. The risk factors for mortality in AL patients admitted to the ICU exhibit dynamic changes across different stages. For ICU survivors, optimizing nutritional support and initiating anti-tumor treatment as early as possible after discharge are crucial for improving prognosis.