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. 2017 Nov:62:51-55.
doi: 10.1016/j.leukres.2017.09.017. Epub 2017 Sep 27.

Outcomes and changes in code status of patients with acute myeloid leukemia undergoing induction chemotherapy who were transferred to the intensive care unit

Tamjeed Ahmed  1 , Abby L Koch  2 , Scott Isom  3 , Heidi D Klepin  1 , Jonathan M Bishop  4 , Leslie R Ellis  1 , Dmitriy Berenzon  1 , Dianna Howard  1 , Susan Lyerly  1 , Bayard L Powell  1 , Timothy S Pardee  5
Affiliations

Outcomes and changes in code status of patients with acute myeloid leukemia undergoing induction chemotherapy who were transferred to the intensive care unit

Tamjeed Ahmed et al. Leuk Res. 2017 Nov.

Abstract

Patients with Acute Myeloid Leukemia (AML) have compromised marrow function and chemotherapy causes further suppression. As a result complications are frequent, and patients may require admission to the intensive care unit (ICU). How codes status changes when these events occur and how those changes influence outcome are largely unknown. Outcomes for adult patients with AML, undergoing induction chemotherapy, and transferred to the ICU between January 2000 and December 2013 were analyzed. 94 patients were included. Median survival was 1.3 months. At 3 and 6 months overall survival (OS) was 27% and 18% respectively. Respiratory failure was the most common reason for transfer to ICU (88%), with 63% requiring mechanical ventilation at transfer. Other reasons included: cardiac arrest (18%), septic shock (17%), hypotension (9%), and acute renal failure (9%). The most frequent interventions were mechanical ventilation in 85%, vasopressors in 62%, and hemodialysis in 30%. Following transfer 55 patients (58%) had a change in code status. Overall, 46 patients (49%) changed from Full Code (FC) to Comfort Care (CC), 7 (7%) from FC to Do Not Resuscitate (DNR), and 2 (2%) from DNR to CC. For the entire cohort, ICU mortality (IM) was 61% and hospital mortality (HM) was 71%. For FC or DNR patients, IM was 30% and HM was 41%. For CC patients, IM was 90% and HM was 100%. Overall, 27 patients (29%) survived to discharge. Of those discharged, 22 (81%) were alive at 3 months and 17 (63%) were alive at 6 months. In conclusion, patients that required ICU admission during induction chemotherapy have a poor prognosis. Code status changed during the ICU stay for the majority of patients and always to a less aggressive status.

Keywords: Acute myeloid leukemia; Code status; ICU.

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Figures

Figure 1
Figure 1. Overall survival of all patients (n=94)
Survival rates for the entire cohort. Kaplan-Meier curves for all patients transferred to the ICU.
Figure 2
Figure 2. Overall survival by Code Status
Survival of cohort by code status. Kaplan-Meier curves for patients are shown for patients with full code/DNR compared to those who were comfort care.
Figure 3
Figure 3. Overall survival of patients discharged from hospital (n=27)
Survival rates for patients who were discharged from the hospital. Kaplan-Meier curves for all patients who survived to hospital discharge.
See this image and copyright information in PMC

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