Novel insights and clinical perception of the patients with acute leukemia transferred to ICU: a multi-center retrospective study spanning 10 years

Qicai Guo¹Yanquan Liu²Xiaojun Chen³Jianzhen Shen⁴Zuotao Li¹Minjuan Zeng⁵Yue Yin⁴Jiachen Xie¹Ye Li¹Huidong Guo¹Zuohong Cao^1*

• ¹First Affiliated Hospital of Gannan Medical University, Ganzhou, China
• ²Nanchang University Jiangxi Medical College, Nanchang, China
• ³Affiliated Hospital of Putian University, Putian, China
• ⁴Fujian Medical University Union Hospital, Fuzhou, China
• ⁵Guangdong Medical University, Zhanjiang, China

A total of 357 AL patients, aged 16.5~77 years, were included in this study, comprising 216 males and 141 females. The time interval from AL diagnosis to ICU admission ranged from 0.03 to 144 months, with a median of 1 month. The length of ICU stay varied between 1 and 30 days. And we found FLTS-ITD was independent risk factors for mortality of AML, while E2A-PBX1 and DNMT3A were independent risk factors for mortality of ALL. Regardless of whether the subtype of AL patients included in this study was AML or ALL, patients with complex karyotypes accounted for the largest proportion. Meanwhile, age, leukemia type , heart failure, APACHE Ⅱ score , WBC, PLT, LDH, PCT, APTT significantly affected the time from diagnosis to transfer to the ICU in AL patients (P < 0.05), accompanied by the gene mutation of WT1, FLT3-ITD, and TP53 significantly affected the time from diagnosis to transfer to the ICU in AML patients (P <0.05), and FLT3-ITD, E2A-PBX1, DNMT3A, HOX11, RUNX1 significantly affected the time from diagnosis to transfer to the ICU in ALL patients (P < 0.05). Univariate analysis revealed that heart failure, sepsis, continuous renal replacement therapy (CRRT), administration of two or more treatments simultaneously, APACHE II score ≥20, and procalcitonin (PCT) levels were significantly associated with prognosis. Multivariate analysis indicated that heart failure, CRRT, and APACHE II score ≥20 were independent risk factors for mortality. COX univariate analysis suggested that heart failure, vasopressor use, and APACHE II score were influencing factors for overall survival (OS), while multivariate analysis confirmed that vasopressor use was an independent risk factor for OS. The prognosis and outcomes for AL patients transferred to the ICU were generally poor. Some molecular biological and cytogenetic indicators can be used as early warning indicators for AL patients’ transfer to the ICU or short-term death. Acute respiratory failure, sepsis, and severe infections were the primary reasons for ICU admission. Heart failure, CRRT, and APACHE II score ≥20 were identified as independent risk factors for mortality, while vasopressor use was an independent risk factor for OS.