• Frank Kroschinsky, Matthias Weise, Thomas Illmer, Mathias Haenel, Martin Bornhaeuser, Gert Hoeffken, Gerhard Ehninger, and Ulrich Schuler.
• Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität, Fetscherstrasse 74, 01307 Dresden, Germany. kroschinsky@mk1.med.tu-dresden.de
• Intensive Care Med. 2002 Sep 1; 28 (9): 1294-300.

ObjectiveTo assess the outcome of intensive care unit (ICU) treatment in patients with hematological malignancies.Design And SettingRetrospective cohort study in the medical ICU of a university hospital.Patients104 critically ill patients after receiving conventional chemotherapy or autologous hematopoietic stem cell transplantation.InterventionsWe analyzed demographic data, underlying disease, intensity of antineoplastic regimen, cause of admission, need for mechanical ventilation, and hemofiltration, ICU survival, and survival after discharge, furthermore neutrophil count, C-reactive protein (150 mg/l), antithrombin III, prothrombin time, and SAPS II (50) at ICU admission. All recorded variables were evaluated for prognostic relevance by univariate and multivariate analyses.Measurements And ResultsOverall ICU mortality was 44%, with significantly higher mortality in ventilated patients (74% vs. 12% in nonventilated patients, p<0.001). Overall survival for the entire group 6 months and 1 year after ICU admission was 33% and 29%, respectively. Multivariate analysis revealed mechanical ventilation and SAPS II as independent prognostic factors of both ICU mortality and long-term survival, while C-reactive protein predicted only ICU mortality.ConclusionsThe outcome of patients not requiring ventilatory support in this study was encouraging, while invasive ventilation was again confirmed as predicting a dismal prognosis in this population. Efforts should be directed to avoiding this procedure by reducing the pulmonary toxicity of antineoplastic treatment and to making ventilatory support more tolerable.

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