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Erschienen in: Intensive Care Medicine 3/2009

01.03.2009 | Original

Continued survival gains in recent years among critically ill myeloma patients

verfasst von: Vincent Peigne, Kateřina Rusinová, Lionel Karlin, Michael Darmon, Jean-Paul Fermand, Benoît Schlemmer, Élie Azoulay

Erschienen in: Intensive Care Medicine | Ausgabe 3/2009

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Abstract

Objective

Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients.

Design

Retrospective study.

Setting

Intensive care unit.

Patient

Consecutive myeloma patients admitted to a teaching hospital ICU between 1990 and 2006. We compared three year-of-admission groups (1990–1995, 1996–2001, and 2002–2006) that matched changes in myeloma treatment (chemotherapy only, stem cell transplantation, and new molecules, respectively).

Intervention

None.

Measurements and main results

We included 196 patients. Reasons for ICU admission and patient characteristics were similar across groups; however, less use of conventional chemotherapy and radiotherapy and greater use of steroids were noted in the more recent periods. Over time, vasopressors and invasive mechanical ventilation were used decreasingly, and noninvasive ventilation increasingly, to treat acute respiratory failure. Hospital mortality decreased from 75% in 1990–1995 to 49% in 1996–2001 and 40% in 2002–2006 (= 0.0007). Mortality was associated with poor performance status [OR 2.27, 95% CI (1.04–4.99)], need for mechanical ventilation [OR 4.33, 95% CI (1.86–10.10)], need for vasopressors [OR 2.57, 95% CI (1.12–5.86)], and admission for an event related to myeloma progression [OR 2.77, 95% CI (1.13–6.79)]. ICU admission within 48 h after hospital admission was associated with lower mortality [OR 0.28, 95% CI (0.19–0.89)].

Conclusion

Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.
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Metadaten
Titel
Continued survival gains in recent years among critically ill myeloma patients
verfasst von
Vincent Peigne
Kateřina Rusinová
Lionel Karlin
Michael Darmon
Jean-Paul Fermand
Benoît Schlemmer
Élie Azoulay
Publikationsdatum
01.03.2009
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 3/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1320-4

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