Patients with hematologic malignancies (HMs) have a significantly elevated risk of mortality compared to other cancer patients treated in the intensive care unit (ICU). The prognostic impact of numerous poor outcome indicators has changed, and research has yielded conflicting results. This study aims to determine the ICU and hospital outcomes and risk factors that predict the prognosis of critically ill patients with HMs. In this retrospective study, conducted at a referral hospital in Taiwan, 213 adult patients with HMs who were admitted to the medical ICU were evaluated. We collected clinical data upon hospital and ICU admission. Using a multivariate regression analysis, the predictors of ICU and hospital mortality were assessed. Then, a scoring system (Hospital outcome of critically ill patients with Hematological Malignancies (HHM)) was built to predict hospital outcomes. Most HMs (76.1%) were classified as high grade, and more than one-third of patients experienced a relapsed or refractory disease. The ICU and hospital mortality rates were 55.9% and 71.8%, respectively. Moreover, the disease severity was high (median Sequential Organ Failure Assessment (SOFA) score: 11 and Acute Physiology and Chronic Health Evaluation (APACHE II) score: 28). The multivariate analysis revealed that high-grade HMs, invasive mechanical ventilation requirement, renal replacement therapy initiation in the ICU, and a high SOFA score correlated with ICU mortality. Furthermore, a higher HHM score predicted hospital mortality. This study demonstrates that ICU mortality primarily correlates with the severity of organ dysfunction, whereas the disease status markedly influences hospital outcomes. Furthermore, the HHM score significantly predicts hospital mortality.

Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56–0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45–0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.

Emerging evidence highlights that respiratory syncytial virus (RSV) poses a significant risk to older adults. However, detailed clinical data on elderly patients hospitalized with RSV remains limited. This study investigates the clinical characteristics and outcomes of older adults (aged ≥50 years) hospitalized with RSV infection. This retrospective cohort study included hospitalized patients aged ≥50 years with respiratory symptoms and laboratory-confirmed RSV infection at China Medical University Hospital between January 1, 2011, and December 31, 2023. Data on demographic characteristics and clinical presentations were collected. RSV infection-related outcomes were analyzed across various subgroups. This study included 36 patients, with the most prevalent comorbidities being diabetes mellitus (47.2 %), immunocompromised status (36.1 %), and chronic lung disease (30.6 %). Pneumonia was identified in 72.2 % of patients, while 41.7 % required invasive mechanical ventilation, and the hospital mortality rate was 33.3 %. Non-survivors had higher rates of comorbidities, particularly chronic lung disease (66.7 % vs. 12.5 %, p = 0.002), higher disease severity, elevated procalcitonin levels, and were more likely to develop septic shock and acute respiratory distress syndrome. A bacterial coinfection rate of 33.3 % was observed, with patients experiencing pneumonia or bacterial coinfection showing poorer outcomes. Moreover, patients with chronic lung disease exhibited significantly worse day-28 survival (log-rank p < 0.001). The disease burden of RSV in older adults is amplified by comorbidities such as chronic lung disease, with pneumonia and bacterial coinfections further worsening outcomes. Our findings highlight the need for a more comprehensive understanding and effective preventive strategies to protect this vulnerable population.

BackgroundPatients with a hematologic malignancies (HM) have one of the highest mortality rates among cancer patients admitted to the medical intensive care unit (ICU). The aim of this study was to identify outcomes and risk factors that predict the prognosis of critically ill patients with HM in the ICU.MethodsA retrospective observational study was conducted in a tertiary referral hospital in Taiwan over 40 months (January 1, 2017–April 30, 2020). All adult patients with HM who were admitted to medical ICU were enrolled. Clinical data upon hospital and ICU admission were collected. The predictors of ICU mortality were evaluated using a multivariate analysis.ResultsA total of 233 patients with HM met the inclusion criteria. The median age (SD) was 59.3 (15.1) years, and 76% of the HMs were classified as high-grade disease. The median (IQR) Sequential Organ Failure Assessment (SOFA) score at ICU admission was 11 (9–15); Simplified Acute Physiology Score II, 64 (51–80); and Acute Physiology and Chronic Health Evaluation II score, 28 (23–34). The most common reasons for ICU admission were acute respiratory failure (63.1%) and septic shock (19.7%). The ICU and hospital mortality rates were 54.1% and 67.8%, respectively. A multivariate analysis revealed that the initiation of renal replacement therapy in the ICU (odds ratio [OR], 3.88; 95% CI, 1.66–9.08) and SOFA score (OR, 1.16; 95% CI, 1.03–1.31) were independently associated with ICU mortality.ConclusionsThe ICU and hospital outcomes of critically ill patients with HM are improving. Performance status, cancer status, invasive mechanical ventilation, severe neutropenia, and transplantation status were not identified as predictive factors of ICU outcome. Initiation of renal replacement therapy in the ICU and the SOFA score upon ICU admission were independently associated with ICU mortality. We suggest early and timely ICU admission of patients at risk of multiorgan failure.