Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Peyton Martin, BS
Research Assistant
The University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Juliana Heatter, MD
Research Assistant
The University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Maria Reyes Ramirez, MD
Resident physician
Louisiana State University Health Science Center
New Orleans, Louisiana, United States
Disclosure information not submitted.
Nisha Rathi, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Cristina Gutierrez, MD
Associate Professor of Critical Care Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Dereddi Raja Reddy, MD, FACP FCCP
Assistant Professor, Program Director MS4 McGovern Medical School
MD Anderson Cancer Care Center
Houston, Texas
Disclosure information not submitted.
Joshua Botdorf, DO
Assistant Professor
University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Sajid Haque, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
.jpg "Kristen Price, MD, FCCP photo")
Kristen Price, MD, FCCP
Chair, Department of Critical Care and Respiratory Care
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure information not submitted.
Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Title: Outcomes of Critically Ill Patients with Acute Leukemias and Septic Shock
INTRODUCTION/HYPOTHESIS:
Leukemic patients receive intensive chemotherapy which frequently results in immunosuppression associated severe infections. Data on outcomes of septic shock have been poorly studied in this specific population. The aim of our study was to describe the outcomes of patients with acute leukemia admitted to the intensive care unit (ICU) with septic shock.
Methods:
We studied a cohort of acute leukemia admitted with the diagnosis of septic shock to the Intensive Care Unit (ICU) between 04/01/2016 and 03/31/2019. We collected demographics, Charlson Comorbidity Index (CCI), severity of illness scores, mechanical ventilation days, time on vasopressors, resource utilization, and outcomes.
Results:
Among 809 cancer patients admitted to the ICU with septic shock within the study period 256 (32%) had acute leukemia. Of them, 201 (79%) had acute myeloid leukemia, and 55 (21%) had acute lymphoblastic leukemia. Their median age was 61 years (IQR 44.3-70), and 41% of them were female. The median CCI was 4 (3-6). Most of them (68%) were admitted to ICU from the hospital wards. At the time of ICU admission, half of them (52%) had a relapsed/refractory malignancy, 14% were on remission, 29% had active disease and only 5% of them had newly diagnosed disease. Most of the patients (83%) had severe neutropenia (ANC < 500 cells/mm3). Twenty-six percent of patients had undergone allogeneic stem cell transplant and 14% developed graft versus host disease. The median admission SOFA score was 11 (9-14) and maximum SOFA score was 14 (10-17). The median time on vasopressors was 31.48 (11.9-69.1) hours. A total of 171 (67%) patients had respiratory failure, 144 (56%) of them required intubation, and their median ventilator-days was 6.55 (2.72-12.97) days. Renal replacement therapy was required by 18% of the patients. The median pre-ICU length of stay (LOS) was 7 (0-24) days, ICU LOS was 5 (2-10) days, and hospital LOS was 22 (9-41.8) days. The ICU, 28-day. hospital, and 90-day mortality rates were 69%, 73%, 77%, and 81%, respectively.
Conclusions:
We found high mortality rates in this cohort of critically ill patients with acute leukemias and septic shock. Despite all efforts to improve the outcomes of septic shock, populations such as patients with acute leukemias remain vulnerable and