Universität zu Köln

Pohlen, Michele, Thoennissen, Nils H., Braess, Jan, Thudium, Johannes, Schmid, Christoph, Kochanek, Matthias, Kreuzer, Karl-Anton, Lebiedz, Pia, Goerlich, Dennis, Gerth, Hans U., Rohde, Christian, Kessler, Torsten ORCID: 0000-0001-7679-5362, Mueller-Tidow, Carsten, Stelljes, Matthias, Buechner, Thomas, Schlimok, Guenter, Hallek, Michael, Waltenberger, Johannes, Hiddemann, Wolfgang, Berdel, Wolfgang E., Heilmeier, Bernhard and Krug, Utz (2016). Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction. PLoS One, 11 (8). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU. Methods and Results Multivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operatorcharacteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of >= 25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge. Conclusions Our data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit from intensive care.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pohlen, Michele UNSPECIFIED UNSPECIFIED UNSPECIFIED Thoennissen, Nils H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Braess, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Thudium, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmid, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Kreuzer, Karl-Anton UNSPECIFIED UNSPECIFIED UNSPECIFIED Lebiedz, Pia UNSPECIFIED UNSPECIFIED UNSPECIFIED Goerlich, Dennis UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerth, Hans U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kessler, Torsten UNSPECIFIED orcid.org/0000-0001-7679-5362 UNSPECIFIED Mueller-Tidow, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Stelljes, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Buechner, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlimok, Guenter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Waltenberger, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Hiddemann, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Berdel, Wolfgang E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heilmeier, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Krug, Utz UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-266176
DOI:	10.1371/journal.pone.0160871
Journal or Publication Title:	PLoS One
Volume:	11
Number:	8
Date:	2016
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL PATIENTS; PROGNOSTIC-FACTORS; COMPLETE REMISSION; APACHE-II; MULTICENTER; SURVIVAL; CANCER; SCORE; TRANSPLANTATION; CHEMOTHERAPY Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26617