Сritical conditions in complicated patients with oncohematological diseases

Summary

Introduction

The aim of this study was to assess a direct connection between the development of multiple organ failure syndrome with duration of treatment and outcomes of cytostatic chemotherapy.

Patients and Methods

We performed a retrospective analysis of 138 adult patients with oncohematological disorders treated with different chemotherapy regimens, followed by admittance to intensive care unit (ICU). The data analysis was performed by assessing functional state of patient’s organs and systems using a SOFA scale for evaluation of critical states.

Results

Significant coagulopathies were diagnosed in more than 120 patients (86.9% of total group); acute respiratory failure, in 43 cases (31.2%); impaired consciousness, 9 (6.5%); acute renal failure, 25 (18,1% ); cardiovascular disorders, 58 (42.0%); acute liver failure, 34 (24.6%). It is also noteworthy that the multiple organ dysfunction occurred in 68 (49.3%) patients, and sepsis, in 24 patients (17.4%). In 78 patients (56.6%), a multiple organ failure (MOF) has been developed after chemotherapy. When summarizing clinical outcomes in the ICU-treated critical care patients, 91 subjects (65.9%) were returned to a somatic department in satisfactory state. Meanwhile, 47 patients were deceased (34.1%). Assessment of organ failure in MOF patients and their clinical course was quantified by means of SOFA scale. Among 47 deceased patients (34.1%) who died with complications refractory to critical care therapy, the SOFA values were estimated as 19.5 ± 0.5 points. In 91 patients, the degree of organ failure was 3 to 5 points, and 20 points, for 47 patients. Disorders of cardiovascular system and blood clotting dominated among those cases.

Conclusion

The data obtained can be used for prediction of lethal outcomes in oncohematological patients brought to the ICU due to evolving multiple organ failure.

Keywords

Chemotherapy, intensive care, survival, blood malignancies