Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study

Carolina Secreto; Dara Chean; Andry van de Louw; Achille Kouatchet; Philippe Bauer; Marco Cerrano; Etienne Lengliné; Colombe Saillard; Laurent Chow-Chine; Anders Perner; Peter Pickkers; Marcio Soares; Jordi Rello; Frédéric Pène; Virginie Lemiale; Michael Darmon; Sofiane Fodil; Ignacio Martin-Loeches; Sangeeta Mehta; Peter Schellongowski; Elie Azoulay; Djamel Mokart

doi:10.1186/s13613-023-01172-3

Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study

Ann Intensive Care. 2023 Sep 2;13(1):79. doi: 10.1186/s13613-023-01172-3.

Authors

Carolina Secreto^{1

2}, Dara Chean³, Andry van de Louw⁴, Achille Kouatchet⁵, Philippe Bauer⁶, Marco Cerrano⁷, Etienne Lengliné⁸, Colombe Saillard⁹, Laurent Chow-Chine¹⁰, Anders Perner¹¹, Peter Pickkers¹², Marcio Soares¹³, Jordi Rello^{14

15}, Frédéric Pène¹⁶, Virginie Lemiale¹⁷, Michael Darmon¹⁷, Sofiane Fodil¹⁷, Ignacio Martin-Loeches¹⁸, Sangeeta Mehta¹⁹, Peter Schellongowski²⁰, Elie Azoulay¹⁷, Djamel Mokart¹⁰

Affiliations

¹ Division of Haematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy. carolina.secreto@gmail.com.
² Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France. carolina.secreto@gmail.com.
³ Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris Cité University, Paris, France.
⁴ Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA.
⁵ Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France.
⁶ Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Division of Haematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy.
⁸ Hématologie Adulte, Hôpital Saint-Louis, Université Paris Diderot, Paris, France.
⁹ Hematology Department, Institut Paoli-Calmettes, Marseille, France.
¹⁰ Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
¹¹ Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
¹² Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
¹³ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação Em Clínica Médica, Rio De Janeiro, Brazil.
¹⁴ Vall d'Hebron Institute of Research, Barcelona, Spain.
¹⁵ CHU Nîmes, Université de Nîmes-Montpellier, Nîmes, France.
¹⁶ Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France.
¹⁷ Medical Intensive Care Unit, APHP, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France.
¹⁸ Department of Intensive Care Medicine, St. James's Hospital, Dublin, Ireland.
¹⁹ Sinai Health System and University of Toronto, Toronto, ON, Canada.
²⁰ Department of Medicine I, Medical University of Vienna, Vienna, Austria.

Abstract

Background: Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed.

Methods: This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis.

Results: Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality.

Conclusions: Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.

Keywords: Acute myeloid leukemia; Acute respiratory failure; Cluster analysis; Hospital mortality; Intensive care unit.