Factors associated with risk and prognosis of intensive care unit admission in patients with acute leukemia: a Danish nationwide cohort study

Abstract

Identifying risk factors for intensive care unit (ICU) admission in acute leukemia (AL) patients may guide decision-making and improve prognosis. We included all adult AL patients receiving high-intensive chemotherapy in Denmark from 2005 to 2016. We examined risk factors [crude and adjusted (a) relative risks (RRs) with 95% confidence intervals (CI)] and calculated RRs of death after 1-, 3-, and 5-years in ICU-admitted patients compared with matched cohorts. In 1417 AML and 306 ALL patients, the 1-year risk of ICU admission was 28.1% for AML and 26.4% for ALL patients, with the majority related to the first course of chemotherapy. Performance status >1 was associated with increased risk. The 1-year mortality was higher in ICU-admitted patients (AML: 69.7 vs. 35.0% [aRR 2.74;CI = 2.17–3.47]; ALL 65.0 vs. 20.0% [aRR 3.04;CI = 1.54–6.02]). The excess mortality decreased with time. In this study, performance status was associated with increased risk of ICU admission and identifies high-risk patients. ICU admission was associated with high mortality, especially within the first year.

Keywords:

• Acute leukemia
• acute myeloid leukemia (AML)
• acute lymphoblastic leukemia (ALL)
• intensive care
• mortality
• risk factors

Acknowledgments

We wish to thank all the individuals who carefully report the available and relevant clinical data to the Danish National Acute Leukemia Registry and the Danish Intensive Care Database.

Ethical approval

According to Danish legislation, no approval from an ethics committee is required for registry-based studies. The study was approved and registered at the Danish Data Protection Agency (Central Denmark record 1-16-02-321-18).

Author contributions

Each of the authors has substantially contributed to conducting the underlying research and drafting of this manuscript. All authors have been involved in conceptualization, visualization, and the writing process. Dr. Cecilie Maeng did the data editing, analyses, and creation of tables/figures under the close supervision of Dr. Lene Østgård, Professor Christian Christiansen, and Professor Kathleen Liu.

Study presentations

Preliminary data was presented at the American Society of Hematology (ASH) conference 2019 in Orlando, Florida.

Disclosure statement

We have no conflicts of interest to declare.

Additional information

Funding

The work and training of Cecilie Velsoe Maeng were supported by the Danish-American Research Exchange (DARE) program and funded generously by the Lundbeck Foundation. The study was additionally supported with grants from the United States National Institutes of Health (KDL, K24 DK 113381), Tømrermester Jørgen Holm og Hustru Elisa F. Hansens Mindelegat, Slagtermester Max Wørzner og Hustru Inger Wørzners Mindelegat, and Raimond og Dagmar Ringgård-Bohns Fond.