Predictive factors of intensive care unit admission in patients with haematological malignancies and pneumonia

Abstract

Objective: To describe early signs at the onset of pneumonia occurring in the haematology ward which could be associated with a transfer to the ICU.

Design: A 13-month preliminary prospective observational cohort study.

Setting: Department of haematology and (32-bed) medical intensive care unit (ICU).

Patients: Fifty-three of 302 patients hospitalised in the haematology ward who developed presumptive clinical evidence of pneumonia were enrolled.

Measurements and results: At the onset of the clinical evidence of pneumonia (day 1), we compared variables between patients requiring an ICU admission and those who did not. Twenty-four patients (45%) required a transfer to the ICU. Factors associated with ICU admission were: numbers of involved quadrants: 2.3 vs 1, P=0.001 and oxygenation parameters (initial level of O(2) supplementation: 3.5 vs 0.9 l/min, P<0.05), the presence of hepatic failure (58% vs 10%, P<0.01), Gram-negative bacilli isolated in blood culture (7 vs 1, P=0.01). In the multivariate analysis, a decrease of 10% in the SaO(2) and the requirement of nasal supplementary O(2) at the onset of acute respiratory failure increased the risk of admission to MICU, respectively, by 18 and by 14. The overall 6-month mortality rate of the 53 patients was 28%.

Conclusion: Parameters of oxygenation and radiological score could be associated with this transfer on day 1 of the onset of pneumonia occurrence. A further study should evaluate an earlier selection of this type of patient, followed by an "early" admission to the MICU, in order to improve ICU outcome.