Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Benjamin Gershkovich^{1

2}, Shannon M Fernando^{3

4}, Brent Herritt³, Lana A Castellucci^{5

6

7}, Bram Rochwerg^{8

9}, Laveena Munshi¹⁰, Sangeeta Mehta¹⁰, Andrew J E Seely^{3

5

6

11}, Daniel I McIsaac^{5

6

12}, Alexandre Tran^{5

11}, Peter M Reardon^{3

4}, Peter Tanuseputro^{5

6

13}, Kwadwo Kyeremanteng^{3

6

13

14}

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. bgers030@uottawa.ca.
² The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. bgers030@uottawa.ca.
³ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
⁹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Medicine, Sinai Health System, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
¹² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹³ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 31455376
PMCID: PMC6712869
DOI: 10.1186/s13054-019-2568-5

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Benjamin Gershkovich et al. Crit Care. 2019.

. 2019 Aug 27;23(1):286.

doi: 10.1186/s13054-019-2568-5.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. bgers030@uottawa.ca.
² The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. bgers030@uottawa.ca.
³ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
⁹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Medicine, Sinai Health System, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
¹² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹³ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 31455376
PMCID: PMC6712869
DOI: 10.1186/s13054-019-2568-5

Abstract

Background: Patients with hematologic malignancies who are admitted to hospital are at increased risk of deterioration and death. Rapid response systems (RRSs) respond to hospitalized patients who clinically deteriorate. We sought to describe the characteristics and outcomes of hematologic oncology inpatients requiring rapid response system (RRS) activation, and to determine the prognostic accuracy of the SIRS and qSOFA criteria for in-hospital mortality of hematologic oncology patients with suspected infection.

Methods: We used registry data from two hospitals within The Ottawa Hospital network, between 2012 and 2016. Consecutive hematologic oncology inpatients who experienced activation of the RRS were included in the study. Data was gathered at the time of RRS activation and assessment. The primary outcome was in-hospital mortality. Logistical regression was used to evaluate for predictors of in-hospital mortality.

Results: We included 401 patients during the study period. In-hospital mortality for all included patients was 41.9% (168 patients), and 145 patients (45%) were admitted to ICU following RRS activation. Among patients with suspected infection at the time of RRS activation, Systemic Inflammatory Response Syndrome (SIRS) criteria had a sensitivity of 86.9% (95% CI 80.9-91.6) and a specificity of 38.2% (95% CI 31.9-44.8) for predicting in-hospital mortality, while Quick Sequential Organ Failure Assessment (qSOFA) criteria had a sensitivity of 61.9% (95% CI 54.1-69.3) and a specificity of 91.4% (95% CI 87.1-94.7). Factors associated with increased in-hospital mortality included transfer to ICU after RRS activation (adjusted odds ratio [OR] 3.56, 95% CI 2.12-5.97) and a higher number of RRS activations (OR 2.45, 95% CI 1.63-3.69). Factors associated with improved survival included active malignancy treatment at the time of RRS activation (OR 0.54, 95% CI 0.34-0.86) and longer hospital length of stay (OR 0.78, 95% CI 0.70-0.87).

Conclusions: Hematologic oncology inpatients requiring RRS activation have high rates of subsequent ICU admission and mortality. ICU admission and higher number of RRS activations are associated with increased risk of death, while active cancer treatment and longer hospital stay are associated with lower risk of mortality. Clinicians should consider these factors in risk-stratifying these patients during RRS assessment.

Keywords: Chemotherapy; Critical care; Hematology; Malignancy; Mortality; Sepsis.

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Conflict of interest statement

Dr. Andrew J. E. Seely holds patents related to multiorgan variability analysis and has shares in Therapeutic Monitoring Systems Inc. The other authors declare that they have no competing interests.

Figures

**Fig. 1**
Reasons for rapid response system activation in hematologic oncology patients

See this image and copyright information in PMC

Comment in

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration: another time, another way.
Civantos B, Añón JM, Yus S, Asensio MJ, García-de-Lorenzo A. Civantos B, et al. Crit Care. 2019 Dec 23;23(1):419. doi: 10.1186/s13054-019-2714-0. Crit Care. 2019. PMID: 31870455 Free PMC article. No abstract available.

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Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Affiliations

Outcomes of hospitalized hematologic oncology patients receiving rapid response system activation for acute deterioration

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

LinkOut - more resources

Full Text Sources

Molecular Biology Databases