Background: Acute leukemia (AL) can lead to life-threatening complications and often requires treatment in the Intensive Care Unit (ICU). Our previous study found that patients with AL showed a poor prognosis after ICU admission. The aim of this study was to assess the prognostic changes of AL patients admitted to the intensive care unit in recent years, to analyze the basic characteristics of ICU patients, changes in treatment patterns, and to identify risk factors affecting patient prognosis, thereby providing further guidance for the clinical management of critically ill leukemia patients.

Methods: This was a single-center, retrospective study, including 126 patients diagnosed with AL and admitted to the ICU between 2008 and 2023, with the study period divided into four-year intervals.

Results: A total of 37 patients with acute lymphoblastic leukemia (ALL) and 89 patients with acute myeloid leukemia (AML) were included, with a median age of 40 years (14-81). The most common reason for ICU admission was respiratory failure (46%), followed by shock (17.5%). The average age of patients admitted to the ICU was similar during the study period, but there was a trend towards a decrease in criticality scores, including APACHE Ⅱ and SOFA scores, and a prolongation of the mean length of stay in the ICU at the time of ICU admission. The ICU mortality rate for the entire cohort of patients was 57.9%, ICU mortality decreasing from 72.7% in 2008-2011 to 46.5% in 2020-2023, and similarly, the 1-month mortality rate (90% to 46.5%) and the 6-month mortality rate (90% to 46.5%) have also decreased. The use of invasive ventilation and vasopressor drugs decreased (72.7% and 86.4% to 51.2% and 62.8%), while use of non-invasive ventilation (22.7% to 32.5%) and dialysis increased (0% to 20.9%). It should be emphasized that the detection rate of pathogens in infected patients rose from 36.4% to 74.4%, which were due to the application of bronchoalveolar lavage fluid and next-generation sequencing (NGS) in detecting the pathogens. Notably, despite the reduction in invasive ventilation, there was a significant increase in the mean duration of invasive ventilation. Multivariate analysis showed that the independent risk factor associated with ICU mortality was invasive ventilation treatment (OR=13.068), whereas ICU length of stay longer than 7 days (OR=0.18), direct admission to the ICU (OR=0.155), and disease remission status at ICU admission (OR=0.071) were protective factors.

Conclusion: In conclusion, ICU mortality and 6-month mortality for AL patients with ICU admission were decreased from 2008 to 2023. Concurrently, ICU treatment patterns changed, with prolonged stay in the ICU, increased use of non-invasive ventilation treatment, decreased use of invasive treatments, and a significant increase in pathogen detection rates in infected patients.

Disclosures

No relevant conflicts of interest to declare.

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2024
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