The Need for Respiratory Support in Acute Leukemia: Frequency, Risk Factors and Prognosis

INTRODUCTION: Acute leukemia is a group of heterogeneous diseases characterized by proliferation of blastic cells in bone marrow. and high mortality and morbidity are seen during the disease and treatment course. In these patients, respiratory failure are found that related to the high mortalities. In this study, we aimed to determine rate of respiratory support, prognostic factors and risk factors for acute leukemia.
METHODS: All acute leukemia patients followed in our center between 2003 and 2014 were included in this study, retrospectively. Extra-pulmonary causes (neurological causes, hemodynamic instability and cardiopulmonary arrest) which were excluded from the statistical calculations for risk analysis and prognosis. Demographic characteristics of patients, respiratory support rate and etiologies, risk factors for respiratory failure and prognostic factors were determined and overall survival of patients who needed respiratory support was determined..
RESULTS: Totally, 460 patients included to the study. The rate of respiratory support was 30.6% (139/460) and pneumonia was the most common cause of respiratory failure. In multivariate analysis, age, ECOG performance status, febrile neutropenia prophylaxis, pulmonary infiltration during neutropenia episode and induction or reinduction chemoterapies were determined as independent risk factors for respiratory failure in acute leukemia. A statistical model for risk prediction was developed based on regression coefficient of independent risk factors, and 6 points and more were considered as high risk. The 60-days overall survival of patients who needed mechanical ventilation was 5.5%.
DISCUSSION AND CONCLUSION: In this study, we found that the need for respiratory support during acute leukemia treatment was quite frequent. As determination of high risk patients may provide important clinical benefits, validation of our risk scoring system by appropriately designed studies has utmost importance.

Akut Lösemi Hastalarýnda Mekanik Ventilasyon Ýhtiyacý: Sýklýk, Risk Faktörleri ve Prognozu Etkileyen Faktörlerin Belirlenmesi

GÝRÝÞ ve AMAÇ: Akut lösemiler kemik iliðinde blastik hücrelerin kontrolsüz çoðalmasý ile karekterize heterojen bir hastalýk grubudur. Tedavi ve hastalýk seyrinde yüksek mortalite ve morbidite görülebilir. Bu hasta grubunde solunum yetmezliði yüksek mortalite ile iliþkili bulunmuþtur. Bu çalýþmada akut lösemi hastalarýnda solunum destek ihtiyacý geliþim oranýnýn, risk faktörlerinin ve prognostik faktörlerin belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 2003–2014 yýllarý arasýnda takip edilen tüm akut lösemi hastalarý çalýþmaya retrospektif olarak dâhil edildi.Ekstrapulmoner nedenle solunum desteði ihtiyacý duyan hastalar risk faktörleri ve prognozun belirlenmesi ile ilgili istatistiksel analizlere dâhil edilmediler Hastalarýn demografik özellikleri, solunum destek ihtiyacý oraný ve nedenleri, solunum yetmezliði geliþimi için risk faktörleri ve prognozu etkileyen faktörler belirlendi. Solunum desteði gereken hastalarýn saðkalým analizleri yapýldý.
BULGULAR: Toplam 460 hasta çalýþmaya dahil edildi. Tüm akut lösemi hastalarý arasýnda %30,6 oranýnda solunum desteði verildiði saptandý. En sýk neden pnömoni idi. Solunum yetmezliði geliþme riskini belirlemek için yapýlan çok deðiþkenli analiz sonucunda yaþ, ECOG performans skoru, antibiyotik profilaksisi almamak, nötropenik atak sýrasýnda pulmoner infiltrasyon varlýðý ve indüksiyon ya da reindüksiyon kemoterapileri baðýmsýz risk faktörleri olarak saptandý. Baðýmsýz risk faktörlerinin regresyon katsayýlarýna göre puanlama yapýldý ve 6 puan ve üzeri yüksek riskli olarak belirlendi. Hastalarýn 60 günlük total sað kalým ihtimali % 5,5 olarak hesaplandý.
TARTIÞMA ve SONUÇ: Bu çalýþmada akut lösemi hastalarýnda solunum desteði ihtiyacýnýn oldukça sýk olduðu ve yüksek mortalite ile seyrettiði belirlendi. Yüksek riskli hastalarýn saptanabilmesinin önemli klinik faydalarý olabileceði için geliþtirdiðimiz risk skorlamasý uygun çalýþmalarla valide edilerek klinik pratikte kullanýlabilir.