Prevalence of acute liver dysfunction and impact on outcome in critically ill patients with hematological malignancies:
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ORIGINAL ARTICLE
Prevalence of acute liver dysfunction and impact on outcome in critically ill patients with hematological malignancies: a single-center retrospective cohort study Andry Van de Louw 1
&
Kathleen Twomey 1 & Nicholas Habecker 1 & Kevin Rakszawski 2
Received: 5 May 2020 / Accepted: 20 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Patients with hematological malignancies (HM) often require ICU admission, and acute respiratory or renal failure are then independent risk factors for mortality. Data are scarce on acute liver dysfunction (ALD), despite HM patients cumulating risk factors. The objective of this retrospective cohort study was to assess the prevalence of ALD in critically ill HM patients and its impact on outcome. Data of all patients with HM admitted to the medical ICU between 2008 and 2018 were extracted from electronic medical records. ALD was defined by ALT > 165 U/L, AST > 230 U/L, or total bilirubin > 4 mg/dL. Univariate and multivariate logistic regressions were used to analyze hospital mortality. Charts of survivors with ALD were reviewed to assess impact of ALD on subsequent anti-cancer treatment. We included 971 patients (60% male), age 64 (54–72) years, of whom 196 (20%) developed ALD. ALD patients were younger, more frequently had liver cirrhosis or acute leukemia, and had increased severity of illness and vital organ support needs. ALD was associated with hospital mortality in univariate (OR 4.14, 95% CI 2.95–5.80, p < 0.001) and multivariate analysis (OR 1.86, 95% CI 1.07–3.24, p = 0.03). Hospital mortality was 46% in ALD patients; among 106 survivors, a third of patients requiring therapy received it as previously planned, and half of the patients were alive at 1 year. In summary, in a large population of critically ill patients with hematological malignancies, 20% developed ALD, which was an independent risk factor for hospital mortality and occasionally altered further anti-cancer treatment. Keywords Acute liver dysfunction . Hematological malignancy . Mortality . Critical care . Chemotherapy
Introduction Patients with hematological malignancies (HM) frequently require ICU admission during the course of the disease, the main reasons being acute respiratory failure (60%), shock (40%), and acute kidney injury (AKI, 30%) in a large prospective cohort study [1]. Acute respiratory failure and AKI are independent prognostic factors for hospital mortality in this setting [1, 2].
* Andry Van de Louw [email protected] 1
Division of Pulmonary and Critical Care Medicine, Penn State Health Hershey Medical Center, 500 University Dr., Hershey, PA 17033, USA
2
Division of Hematology and Oncology, Penn State Health Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
Acute liver dysfunction (ALD) is part of severity indexes like Sequential Organ Failure Assessment (SOFA) score [3], which are associated with increased mortality in this population [1]. However, the prevalence of acute liver dysfunction and its impact on o
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