Mortality association factors in hematologic cancer patients requiring mechanical ventilation for more than one day in a developing country. A prospective cohort study

Abstract

Background

The potential benefit of intensive care unit (ICU) admission of hematologic cancer patient requiring mechanical ventilation (MV) still controversial especially with increased cost of needed life support measures.

Objective

To seek clinical predictors of ICU mortality in hematologic cancer patients requiring (MV) during the first day of admission to the ICU.

Design, Setting, Participants: 448 patients were included in this prospective observational cohort study, between May 2014 and May 2016 at the oncology center of Mansoura university hospital.

Measurements and Main Results

ICU mortality was (350 out of 448 patients). Indications of (MV) were sepsis (42%), airway/ pulmonary invasion by tumor (33%), cardiopulmonary arrest (3%), coma (16%) and pulmonary embolism (5%). The independent risk factors for mortality were performance status 3–4(odds ratio, 2.49; 95% confidence interval [1.35:4.60]); cancer recurrence/ progression (odds ratio, 9.31;95% confidence interval, [4.18:21.24]); pao2/ fio2 ratio < 150 (odds ratio, 2.47; 95% confidence interval, [1.344:4.68]); airway/ pulmonary involvement by tumor as a cause of M.V. (odds ratio, 6.73; 95% confidence interval, [2.2:10.05]); sequential organ failure assessment score(excluding respiratory points, each 4 points; odds ratio 2.14; 95% confidence interval, [1.16:3.133]); use of vasopressors (odds ratio, 3.39; confidence interval, [1.73:6.44]).

Conclusion

Poor performance status, cancer status, severity of acute organ failure, use of vasopressors and airway/pulmonary involvement by tumor were the main predictors of mortality. Making use of such clinical data may help to provide intensive care for patients with a potential chance of survival.