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The following is a summary of “Severe bleeding events among critically ill patients with haematological malignancies,” published in the October 2024 issue of Critical Care by Vigneron et al.
Researchers conducted a retrospective study to assess the frequency of severe bleeding events in individuals with critical illnesses and hematological malignancies while identifying factors that contribute to these events.
They examined adult patients with hematological malignancy requiring unplanned ICU admission from 2007 to 2018. The primary endpoint was ICU-acquired severe bleeding events (grades 3 or 4 of the World Health Organization classification) after the first 24 hours in the ICU.
The results showed 1012 patients were analyzed, mainly with lymphoma (n=434, 42.9%) and leukemia/myelodysplastic syndrome (n=266, 26.3%). Most were recently diagnosed (n=340, 33.6%) and under active cancer treatment (n=604, 59.7%). The leading cause for admission was infection (n=479, 47.3%), but a significant proportion were admitted for primary hemorrhage (n = 99, 10%). An ICU-acquired severe bleeding events occurred in 109 (10.8%) after 3.0 days [1.0–7.0]. The primary source of bleeding was the gastrointestinal tract (n = 44, 40.3%). Patients experiencing an ICU-acquired severe bleeding event displayed prolonged in-ICU length of stay (9.0 days [1.0–6.0] vs 3.0 [3.5–15.0] in non-bleeding patients, P< 0.001) and worsened outcomes with increased in-ICU and in-hospital mortality rates (55% vs 18.3% and 65.7% vs 33.1%, respectively, P< 0.001). In multivariate analysis, independent predictors of ICU-acquired severe bleeding events were chronic kidney disease (cause-specific hazard 2.00 [1.19–3.31], P= 0.008), a primary bleeding event present at the time of ICU admission (Cause-Specific Hazard (CSH) 4.17 [2.71–6.43], P< 0.001), non-platelet Sequential Organ Failure Assessment (SOFA) score (CSH per point increase 1.06 [1.01–1.11], P=0.02) and prolonged prothrombin time (CSH per 5-% increase 0.90 [0.85–0.96], P=0.001) on the day before the event of interest.
They concluded the major bleeding events common in patients with critical illness and hematological malignancies were linked to worse outcomes, with identified risk factors suggesting the need for closer monitoring or preventive measures.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01383-2