Admission to ICU Associated With Increased Mortality and Comorbidities for Patients With AML

A study published in JAMA Oncology found that patients with acute myeloid leukemia (AML) who were admitted to the intensive care unit (ICU) had greater in-hospital mortality than those who were not (43.1%; n= 4857 vs. 9.3%; n=2,959; p values not reported), and defined risk factors for ICU admission and in-hospital mortality.

Anna B. Halpern, MD, from the hematology/oncology fellowship program at the Fred Hutchinson Cancer Research Center, and authors analyzed data from the University HealthSystem Consortium database of 43,249 adult patients with AML (mean age = 59.5 years) who were hospitalized for any cause between January 1, 2004, and December 31, 2012.

More than one-quarter of patients (26.1%; n=11,277) were admitted to the ICU and 73.9 percent (n=31,972) were not. Patients admitted to the ICU had a mean hospital stay of 22.4 days, compared with 15.3 days for those who were not.

According to a multivariable analysis, independent risk factors associated with admission to the ICU included:

  • age <80 years old (hazard ratio [HR] = 1.56; 95% CI 1.42-1.70)
  • hospitalization in the southern United States (HR=1.81; 95% CI 1.71-1.92)
  • hospitalization at a low- or medium-volume hospital (HR=1.25; 95% CI 1.19-1.31)
  • greater number of comorbidities (HR for 5 vs. 0 comorbidities = 10.64; 95% CI 8.89-12.62)
  • sepsis (HR=4.61; 95% CI 4.34-4.89)
  • invasive fungal infection (HR=1.24; 95% CI 1.11-1.39)
  • pneumonia (HR=1.73; 95% CI 1.63-1.82)

Among those admitted to the ICU, independent risk factors associated with in-hospital mortality included:

  • age ≥60 years old (HR=1.61; 95% CI 1.06-1.26)
  • non-white race/ethnicity (HR=1.18; 95% CI 1.07-1.30)
  • hospitalization on the West Coast (HR=1.19; 95% CI 1.06-1.34)
  • lower number of comorbidities (HR for 5 vs. 0 comorbidities = 18.76; 95% CI 13.7-25.67)
  • sepsis (HR=2.94; 95% CI 2.70-3.21)
  • invasive fungal infection (HR=1.20; 95% CI 1.02-1.42)
  • pneumonia (HR=1.13; 95% CI 1.04-1.24)

Hospitalization costs were higher for patients with AML who were admitted to the ICU: $83,354 versus $41,973, and costs increased with each comorbidity, from $50,543 for those with no comorbidities to $124,820 for those with ≥5 comorbidities.

Source: Halpern AB, Culakova E, Walter RB, Lyman GH. Association of risk factors, mortality, and care costs of adults with acute myeloid leukemia with admission to the intensive care unit. JAMA Oncol. 2016 November 10 [Epub ahead of print]