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The calculation of NEWS requires vital signs such as respiratory rate, peripheral oxygen saturation, need for oxygen therapy, body temperature, arterial pressure, heart rate, and level of consciousness. Each parameter used to calculate the NEWS will be collected least three times a day by the attending nurse.

Real-time calculation of the NEWS with ICU admission if NEWS ≥ 7.

Corentin Orvain, MD PhD

Aurélie Hautefort

Delphine LEBON, PhD

Corentin Orvain, PhD

Yohan Desbrosses, PhD

Marie-Anne Couturier, PhD

Caroline Bonmati, PhD

Pierre Peterlin, PhD

Maria-Pilar Gallego-Hernanz, PhD

Jean-Baptiste Mear, PhD

Emmanuelle Tavernier, PhD

Alban Villate, PhD

Patients with hematologic malignancies requiring intensive chemotherapy are at risk for life-threatening complications. Organ failure may appear rapidly and delay in initiating life-sustaining interventions may result in increased mortality. This encourages great alertness although not all patients require close monitoring. It is therefore critical to identify which patients are the most at risk for clinical deterioration to consider increased surveillance in these patients. The benefit of early intensive care unit (ICU) admission, as soon as the first signs of organ dysfunction appear, must also be clarified. Such an intervention could increase survival of patients by close monitoring and early initiation of organ-specific interventions but could also be responsible for anxiety and increased use of ICU resources.

Many teams have analyzed the impact of early warning systems (EWS) including vital signs to detect organ dysfunction early on. It has been shown that these EWS could positively impact survival in many medical fields (pre-hospital, medicine or surgery departments). A few retrospective studies have explored the impact of EWS in hematology, with overall good prediction for ICU admission and mortality. Until now, it has however not been formally demonstrated that early ICU admission, as soon as the first signs of organ dysfunction appear, could benefit patients with hematologic malignancies. A randomized controlled trial studying the impact of early intervention would clarify the role of such a strategy.

In this study, the investigators will prospectively evaluate the implementation of the National Early Warning Score (NEWS), with systematic referral to the ICU in high-score patients, to improve the survival of patients receiving intensive chemotherapy in ten academic centers. This score is one of the most performant and most frequently used to predict organ failure. Its calculation only requires vital signs such as respiratory rate, peripheral oxygen saturation, need for oxygen therapy, body temperature, arterial pressure, heart rate, and level of consciousness. The investigators will therefore study the impact of ICU admission in patients with high NEWS in a randomized, controlled trial. A cluster randomization is planned in which the centers will be randomized between usual care (control group) and interventional care with transfer to the ICU in the event of a NEWS score ≥7 (interventional group). Each parameter used to calculate the NEWS will be collected at least three times a day by the attending nurse.

Impact of an Early Warning System on the Prognosis of Patients With Hematological Malignancies Receiving Intensive Chemotherapy With or Without Hematopoietic Cell Transplantation.

Impact of an Early Warning System on the Prognosis of Patients With Hematological Malignancies Receiving Intensive Chemotherapy With or Without Hematopoietic Cell Transplantation, a Multicenter Cluster Randomized Study

Hazard Ratio (and its 95% confidence interval) associated with the type of care (control or interventional) in a Cox model explaining the time to occurrence of the composite criterion: in-hospital mortality or initiation of organ support (invasive mechanical ventilation, vasopressors \[Noradrenaline, Dobutamine or Adrenaline\], renal replacement therapy, extracorporeal circulation \[ECMO\]).

It will assess the impact of of the implementation of the NEWS with ICU admission in case of a NEWS ≥ 7, in patients with hematological malignancies receiving intensive chemotherapy.

University Hospital, Angers

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Impact of an Early Warning System on the Prognosis of Patients With Hematological Malignancies Receiving Intensive Chemotherapy With or Without Hematopoietic Cell Transplantation.	NCT06409767	Leukemia Lymphoma Multiple Myelom...	Real-time calcu...	18 Years -	University Hospital, Angers
Impact of an Early Warning System on the Prognosis of Patients With Hematological Malignancies Receiving Intensive Chemotherapy With or Without Hematopoietic Cell Transplantation.	NCT06409767	Leukemia Lymphoma Multiple Myelom...	Real-time calcu...	18 Years -	University Hospital, Angers

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