To provide insights into outcomes among critically ill patients with acute leukemia (AL) and to evaluate ICU admission criteria.
Approach:
Study Design: Individual participant data (IPD) meta-analysis examining ICU mortality and prognostic factors for survival among AL patients.
Data Source: Data from 2003 patients treated in 55 ICUs across 19 countries from January 2000 to July 2023.
Key Findings:
ICU mortality rates have significantly declined from 90% in the 1980s-1990s to approximately 45% recently, reflecting substantial advances in hematological and critical care practices.
The proportion of ICU admissions for patients aged over 65 years has increased from 18% before 2010 to 33% thereafter, indicating a shift in the demographic of critically ill AL patients.
Age above 65 years has been identified as an adverse predictor of in-ICU mortality, which contrasts with findings from earlier studies that may not have fully accounted for the impact of age on outcomes.
Interpretation:
The study confirms that improvements in ICU outcomes for AL patients are evident, particularly due to advancements in treatment modalities and critical care strategies, which have contributed to better survival rates.
Limitations:
The study did not account for treatment response, which is a major determinant of survival outcomes in AL patients.
Goals-of-care discussions remain uncommon in the context of ICU admissions for AL patients, indicating a need for further research to address this gap in clinical practice.
Conclusion:
The management of acute leukemia is evolving with the introduction of new therapeutic options and a better understanding of patient demographics, necessitating a reevaluation of ICU admission criteria to optimize care for this patient population.
