The factors affecting survival in patients followed up with the diagnosis of lymphoma in the intensive care unit

Year 2023, Volume: 48 Issue: 3, 1007 - 1015, 30.09.2023

Kaniye Aydın , Ömer Doğan

https://doi.org/10.17826/cumj.1344207

Abstract

Purpose: This retrospective analysis aimed to elucidate the key factors influencing survival outcomes in patients diagnosed with lymphoma and admitted to an Intensive Care Unit (ICU).
Materials and Methods: The study cohort comprised individuals aged 18 or older diagnosed with lymphoma and admitted to the ICU between November 2015 and February 2023. Data were collected on patients' demographic characteristics, primary hematological diagnoses, reasons for ICU admission, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, clinical trajectory, and 28-day mortality rates. Patients were stratified into two categories based on their mortality outcomes: Survivors and non-survivors.
Results: A total of 165 patients were included in the study, with a mean age of 52.41 ± 17.99 years; 63% were male. Table 1 summarizes the demographic characteristics, clinical trajectories, and 28-day mortality rates. The APACHE II and SOFA scores of the patients were 34 (7–53) and 12 (10–14), respectively. The predominant reasons for ICU admission were sepsis (58.2%) and acute respiratory failure (57.6%). Vasopressor necessity prior to and during ICU stay was 23.6% and 92.4%, respectively. During ICU monitoring, thrombocytopenia, and acute kidney injury (AKI) were observed in 77.6% and 66.4% of patients, respectively; 10% required renal replacement therapy. The 28-day mortality rate was 84.8%. Kaplan-Meier analysis revealed that patients with a SOFA score ≥ 9 had a significantly reduced survival time of 4.5 ± 0.4 days compared to those with lower SOFA scores (14.3 ± 2.6 days). Patients with AKI and those requiring invasive mechanical ventilation (IMV) exhibited reduced survival times of 4.7 ± 0.5 days and 5.6 ± 0.5 days, respectively. Elevated SOFA scores (HR 2.355, 95% CI 1.485–3.734), presence of AKI (HR 1.511, 95% CI 1.055–2.163), and the need for IMV (HR 5.721, 95% CI 1.377–23.770) were significantly correlated with increased 28-day mortality. Receiver Operating Characteristic (ROC) curve analysis identified the optimal SOFA cut-off point for predicting 28-day mortality as nine, with an Area Under the Curve (AUC) of 0.897, sensitivity 83.6% and specificity 92%.
Conclusions: The findings of this study underscore the elevated mortality rates among lymphoma patients admitted to the ICU. Our data suggest that several factors serve as significant predictors of 28-day mortality in this patient population. Specifically, elevated APACHE II scores, SOFA scores, the presence of AKI, and the requirement for IMV emerged as crucial indicators associated with adverse survival outcomes. Consequently, these factors warrant meticulous monitoring and could inform targeted interventions to improve survival rates among lymphoma patients in critical care settings.

Keywords

Lymphoma, Mortality, Intensive care unit, apache ıı score, SOFA score

Thanks

Bu çalışma, 16th World Intensive and Critical Care Congress’inde (26-30 Ağustos 2023) poster bildirisi olarak kabul edildi. Yazarlar, istatistiksel analize katkıda bulunan Yusuf Kemal Arslan'a teşekkür eder.

Yoğun bakım ünitesinde lenfoma tanısı ile takip edilen hastalarda sağkalımı etkileyen faktörler

Abstract

Amaç: Bu retrospektif analiz, lenfoma tanısı konan ve Yoğun Bakım Ünitesine (YBÜ) yatırılan hastalarda sağkalım sonuçlarını etkileyen temel faktörleri aydınlatmayı amaçlamıştır.
Gereç ve Yöntem: Çalışma grubu, Kasım 2015 ile Şubat 2023 arasında lenfoma tanısı konan ve YBÜ'ye kabul edilen 18 yaş ve üzeri bireylerden oluşmaktadır. Hastaların demografik özellikleri, birincil hematolojik tanıları, YBÜ'ye kabul nedenleri, laboratuvar parametreleri, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II skorları, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skorları, klinik seyirleri ve 28 günlük mortalite oranları hakkında veriler toplanmıştır. Hastalar mortalite sonuçlarına göre iki kategoriye ayrılmıştır: Hayatta kalanlar ve ölenler.
Bulgular: Ortalama yaşı 52,41 ± 17,99 yıl olan toplam 165 hasta çalışmaya dahil edilmiştir; hastaların %63'ü erkektir. Tablo 1 demografik özellikleri, klinik seyirleri ve 28 günlük mortalite oranlarını özetlemektedir. Hastaların APACHE II ve SOFA skorları sırasıyla 34 (7-53) ve 12 (10-14)’idi. YBÜ'ye kabulün başlıca nedenleri sepsis (%58,2) ve akut solunum yetmezliğiydi (%57,6). YBÜ'de kalış öncesinde ve sırasında vazopressör ihtiyacı sırasıyla %23,6 ve %92,4 idi. YBÜ izlemi sırasında hastaların sırasıyla %77,6 ve %66,4'ünde trombositopeni ve akut böbrek hasarı (ABH) gözlendi; %10'unda renal replasman tedavisi gerekti. 28 günlük mortalite oranı %84,8 idi. Kaplan-Meier analizi, SOFA skoru ≥ 9 olan hastaların sağkalım süresinin SOFA skoru daha düşük olanlara kıyasla (14,3 ± 2,6 gün) 4,5 ± 0,4 gün daha kısa olduğunu ortaya koymuştur. Akut böbrek hasarı olan ve invaziv mekanik ventilasyon (IMV) gerektiren hastalarda sırasıyla 4,7 ± 0,5 gün ve 5,6 ± 0,5 günlük azalmış sağkalım süreleri görülmüştür. Yüksek SOFA skorları (HR 2.355, %95 CI 1.485-3.734), AKI varlığı (HR 1.511, %95 CI 1.055-2.163) ve IMV ihtiyacı (HR 5.721, %95 CI 1.377-23.770) artmış 28 günlük mortalite ile anlamlı şekilde ilişkiliydi. Alıcı İşlem Karakteristiği (ROC) eğrisi analizi, 28 günlük ölüm oranını tahmin etmede optimal SOFA kesme noktasını dokuz olarak tanımladı; Eğri Altındaki Alan (AUC) 0,897, duyarlılık %83,6 ve özgüllük %92'idi.
Sonuç: Bu çalışmanın bulguları, YBÜ'ye kabul edilen lenfoma hastaları arasındaki yüksek mortalite oranlarının altını çizmektedir. Verilerimiz, bu hasta popülasyonunda çeşitli faktörlerin 28 günlük mortalitenin önemli belirleyicileri olduğunu göstermektedir. Özellikle, yüksek APACHE II skorları, SOFA skorları, AKI varlığı ve IMV gereksinimi, olumsuz sağkalım sonuçlarıyla ilişkili önemli göstergeler olarak ortaya çıkmıştır. Sonuç olarak, bu faktörler titiz bir izlem gerektirmektedir ve kritik bakım ortamlarındaki lenfoma hastalarındaki sağkalım oranlarını iyileştirmek için hedeflenen müdahaleler hakkında bilgi verebilir.

Keywords

Lenfoma, Yoğun Bakım Ünitesi, APACHE II skoru, SOFA skoru, Mortalite

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