{"doi":"10.1111/bjh.17630","title":"Changes in intensive care unit admission rates, organ support, and mortality in patients with acute myeloid leukaemia over a 12‐year period: a Danish nationwide cohort study","abstract":"The mortality of patients with acute myeloid leukaemia (AML) has decreased due to more aggressive treatment including extended use of allogeneic haematopoietic stem cell transplantation (HSCT).1, 2 Although this has improved overall survival, increased treatment toxicity may affect early mortality and need for supportive therapy including intensive care unit (ICU) treatment. We evaluated trends in ICU admission rates, use of organ support, and 1-year mortality both overall and after ICU admission in Danish patients with AML diagnosed from 2005 to 2016. The study included all adult patients with AML registered in the Danish Acute Leukaemia Registry (DNLR)3 diagnosed 2005–2016 and treated with high-intensity chemotherapy. The baseline patient, disease and treatment characteristics were obtained from the DNLR. Information on first ICU admission including use of mechanical ventilation (MV), non-invasive ventilation (NIV), dialysis or vasopressors after AML diagnosis was obtained from the Danish Intensive Care Database (DID).4 Comorbidity and survival status information was obtained from the Danish National Patient Registry (DNRP)5 and the Civil Registration System (CRP),6 respectively. All data sources were linked on an individual level (Appendix Figure S1). We examined rates of ICU-admitted patients with AML within 3 years of diagnosis. We calculated allogeneic HSCT rates, median time to first ICU admission and HSCT. We examined the proportion of ICU-admitted patients receiving organ supportive treatments during the first ICU admission after AML diagnosis, as well as 1-year mortality after diagnosis and after ICU admission. Rates were compared by odds ratios estimated by mixed effects logistic regression, adjusted for potential confounders. We compared rates between 2013 and 2016, and 2009–2012, with 2005–2008 as reference. All analyses were conducted using Stata (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX, USA: StataCorp LP). The study was registered at the Danish Data Protection Agency. More details on data sources, methods and statistics can be found in the Appendix. Overall, 1417 patients with AML were included in the study. Within 3 years of diagnosis, 28·0% were admitted to an ICU with no major change in ICU-admission rates from 2005 to 2008 to 2013–2016 (Table I). The median (interquartile range, IQR) time to first ICU admission increased from 30 (7–116) days to 90 (18–359) days concurrently with HSCT transplantation rates (16·3% in 2005–2008 and 35·1% in 2013–2016). The median (IQR) time to transplantation remained stable at 211 (67–411)days. Patient and disease characteristics are presented in Appendix Table SI. The median (IQR) Simplified Acute Physiology Score (SAPS) II was 55 (45–67) in patients diagnosed 2010–2012 and 52 (44–62) in 2013–2016, suggesting no major change in severity of illness in ICU patients admitted after 2010. The use of MV decreased from 66·7% to 40·6% over the study period, with a parallel increase in the use of NIV from 20·0% to 50·0%. We found no major change in the overall use of ventilation. The use of dialysis and vasopressors decreased over the same time (Fig 1). The 1-year mortality in the entire AML cohort decreased from 36·0% in 2005 to 28·8% in 2016. In ICU-admitted patients (N = 397), the 1-year mortality decreased from 80·0% to 65·6% (Fig 1). The comparison of adjusted rates within distinct periods is presented in Table I. Over a 12-year period, more than a quarter of patients with AML receiving high-intensity chemotherapy were admitted to an ICU within 3 years of diagnosis. Use of allogeneic HSCT increased over the study period, with no major change in the ICU admission rate. The use of MV, dialysis and vasopressors decreased, while the use of NIV increased. Concurrently, the 1-year mortality declined for patients with AML overall and in the subset of ICU-admitted patients. The mortality trends observed are in contrast to a recent large-scale American","journal":"British Journal of Haematology","year":2021,"id":204951,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9621,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":787814,"name":"Lene Sofie Granfeldt Østgård","orcid":"0000-0002-3886-1311","position":1,"is_corresponding":false},{"id":787815,"name":"Christian Fynbo Christiansen","orcid":"0000-0002-0727-953X","position":2,"is_corresponding":false},{"id":108933,"name":"Kathleen D. Liu","orcid":"0000-0003-4891-8649","position":3,"is_corresponding":false},{"id":787813,"name":"Cecilie Velsoe Maeng","orcid":"0000-0002-7205-9330","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":null,"created_at":"2026-07-18T23:51:30.197308Z","pmid":"34101163","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}