The evaluation of clinical and laboratory features that determine the prognosis and admission to intensive care in patients with hematological malignancies

Introduction and Aim: Through to especially intensive and new chemotherapeutic regimens, monoclonal antibodies, hematopoietic stem cell transplantation, supportive and palliative measures, the prognosis of patients with a diagnosis of hematological malignancy (HM) improves compared to the earlier periods. However, HM may still lead to intensive care unit (ICU) admission because of the disease itself or its complications. There is no special scoring system that shows the prognosis of the intensive care (IC) unit during the clinic follow-up of these patients. In our study, it was investigated whether there were criteria showing the prognosis of IC during the clinic follow-up for HM. Materials and Methods: Between 2017 and 2020, 88 patients with a diagnosis of HM who were transferred to the ICU due to the need for IC while they were hospitalized in the Hematology Clinic of MCBU Hafsa Sultan Hospital were included in the study. Laboratory tests and clinical conditions during admission to the clinic and the need for IC were reviewed retrospectively. Diagnosis, demographic characteristics, comorbidity, chemotherapy, infection, transfusion, microbiological cultures, biochemistry and hemogram tests, APACHE-2 and SOFA scores during hospitalization were examined in patients. Results: AML 46 (52.2%), ALL 7 (8%), CML and CLL 2 (2.3%), MM 6 (6.8%), NHL 23 (26.1%), HL 4 (4%) ,5), the overall ICU mortality rate was 78.4% in a total of 88 patients; APACHE-2, mechanical ventilator and vasopressor drug use, reason for hospitalization in the ICU, long service hospitalization and excessive red blood cell transfusion, presence and location of proven growth in microbiological results taken in the clinic, Hct, platelet, creatinine, pH, bilirubin, procalcitonin, CRP , albumin values were as dependent risk factors effective on mortality. SOFA score was determined as the only independent variable associated with mortality [OR 1.74 (95% CI 1.04-2.91) p=0.001]. Conclusion: The SOFA score of patients with HM during transfer to ICU was found to be significant in determining ICU mortality. It would be useful to review transfusion policies, infection-reducing measures in the clinic and antibiotic policies in determining the prognosis in the ICU. Additionally, other issues that need further investigation include examining the criteria for admission to the ICU in patients with HM and the effects of monitoring these patients in special units and establishing standard approaches in follow-up on the prognosis.