Introduction
Patients with haematological malignancy who develop respiratory failure have a very poor prognosis [1,2]. The presence of leukopenia at the time of admission has long been suspected to be associated with worse outcome but no published study has convincingly demonstrated this.
Method
Prospectively entered admission and 12 month follow up data from 1222 admissions to an oncological ICU over a 7 year period ending June 1998 were reviewed. We identified 231 haematological (Leukaemia, Lymphoma or Myeloma) admissions. Patients who had received stem cell transplants (SCT) were identified from a separate database and sub-set analyses were performed.
A cross-query of the central haematology laboratory database was set up to determine the total white cell count of each patient prior to and on admission. Leukopenia was defined as an absolute white cell count of < 1.5 × 106/ml. Statistical analyses were by Fisher's exact test.
Results
152 (66%) of the 231 patients died on the unit, a further 26 died within 30 days of leaving the ICU, a total hospital mortality of 77%.
50/107 (48%) of the neutropenic patients were SCT recipients. Excluding 20 patients with acute leukaemia (white cell counts 49.5-850 × 106/ml), 37/100 (37%) of non-neutropenic patients were SCT recipients (P = 0.16).
Conclusion
Haemato-oncological patients have a significantly greater mortality if they are leukopenic at the time of ICU admission: this is not solely attributable to the increased proportion of stem cell transplant recipients in this group. There is an extremely poor prognosis and a strong trend toward increased mortality in patients with pre-admission leukopaenia of more than 7 days duration.
Table 1.
| Admission | 30 day | 12 month | |
|---|---|---|---|
| WCC | ICU deaths | mortality | mortality |
| < 1.5 | 83/107 (78%) | 91/107 (85%) | 98/107 (92%) |
| > 1.5 | 69/126 (55%) | 86/126 (68%) | 107/126 (85%) |
| P value | < 0.003 | < 0.003 | ns |
| Duration of pre- | |||
| admission | |||
| leukopaenia | ICU deaths | 30 day mortality | |
| < 7 days | 38/54 (70%) | 43/54 (80%) | |
| = 7 days | 45/53 (85%) | 48/53 (91%) | |
| P value | 0.10 | 0.17 | |
References
- Brunet F. et al. Is intensive care justified for patients with haematological malignancies? Intensive Care Med. 1990;16:291–297. doi: 10.1007/BF01706352. [DOI] [PubMed] [Google Scholar]
- Rubenfeld G, Crawford SW. Withdrawing life support from mechanically ventilated recipients of bone-marrow transplants. Ann Int Med. 1996;125:625–633. doi: 10.7326/0003-4819-125-8-199610150-00001. [DOI] [PubMed] [Google Scholar]