Short‐ and long‐term outcomes of AL amyloidosis patients admitted into intensive care units |
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| Authors: | Damien Guinault Emmanuel Canet Antoine Huart Arnaud Jaccard David Ribes Laurence Lavayssiere Marion Venot Olivier Cointault Murielle Roussel Marie‐Béatrice Nogier Claire Pichereau Virginie Lemiale Bertrand Arnulf Michel Attal Dominique Chauveau Elie Azoulay Stanislas Faguer |
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| Affiliation: | 1. Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, CHU de Toulouse, Toulouse, France;2. Service de Réanimation médicale, H?pital Saint‐Louis, AP‐HP, Paris, France;3. Service d'Hématologie, Centre de référence des amyloses AL, H?pital Dupuytren, Limoges, France;4. Service d'Hématologie, Institut Universitaire du Cancer de Toulouse, Oncop?le, Toulouse, France;5. Service d'Hématologie, H?pital Saint‐Louis, AP‐HP, Paris, France;6. Université Toulouse III, Toulouse, France;7. Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut des maladies cardiovasculaires et métaboliques, Toulouse, France |
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| Abstract: | Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit‐related organ dysfunction or therapy‐related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28‐d and 6‐month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo‐Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on‐going chemotherapy at ICU admission significantly predicted death at 6 months. Short‐term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on‐going chemotherapy for active amyloidosis impacted on long‐term outcomes. |
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| Keywords: | amyloidosis intensive care unit outcome monoclonal gammopathy |
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