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- Title
Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome.
- Authors
Benoit, Dominique D.; Depuydt, Pieter O.; Peleman, Renaat A.; Offner, Fritz C.; Vandewoude, Koenraad H.; Vogelaers, Dirk P.; Blot, Stijn I.; Noens, Lucien A.; Colardyn, Francis A.; Decruyenaere, Johan M.
- Abstract
<bold>Objective: </bold>To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies.<bold>Design and Setting: </bold>Prospective observational study in a 14-bed medical ICU at a tertiary university hospital.<bold>Patients: </bold>A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels.<bold>Results: </bold>In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications.<bold>Conclusions: </bold>Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.
- Subjects
BACTERIAL diseases; HEMATOLOGICAL manifestations of general diseases; BLOOD diseases; HOSPITAL care; C-reactive protein; ACUTE phase proteins; COMMUNICABLE diseases; INFLAMMATORY mediators; BACTERIAL disease complications; DIAGNOSIS of bacterial diseases; LEUKEMIA complications; DIAGNOSIS; DOCUMENTATION; INTENSIVE care units; LIFE support systems in critical care; MYCOSES; SEVERITY of illness index; HOSPITAL mortality; DISEASE complications
- Publication
Intensive Care Medicine, 2005, Vol 31, Issue 7, p934
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-005-2599-z