Recent evidence has identified several common pathways to ICU admission for patients with amyloidosis:
- Undiagnosed amyloidosis presenting with acute organ failure
- Approximately 35-45% of patients receive their initial diagnosis of amyloidosis during critical illness
- Most common presenting syndromes: acute heart failure (61%), cardiogenic shock (28%), respiratory failure (24%)
- Commonly precipitated by intercurrent illness or medication changes
2. Known amyloidosis with disease progression
- Approximately 38% of ICU admissions occur in patients with established diagnosis
- Progressive cardiac involvement leading to hemodynamic compromise
- Renal deterioration requiring urgent renal replacement therapy
- Treatment complications (e.g., post-chemotherapy sepsis)
3. Procedural complications
- Bleeding complications during diagnostic or therapeutic procedures
- Post-biopsy complications
- Autologous stem cell transplant-related toxicity
4. Arrhythmic events
- Arrhythmia is the primary reason for ICU admission in approximately 22% of cases
- Sudden cardiac death with successful resuscitation
- High-grade conduction disturbances
- Atrial arrhythmias with hemodynamic compromise
Current evidence from multiple centers examining amyloidosis patients admitted to ICU reveals:
- Median age at ICU admission: 65 years
- Cardiac involvement: 73% of patients
- Mechanical ventilation required: 56%
- Vasopressor support needed: 68%
- Renal replacement therapy initiated: 44%
- ICU mortality: 38%
- In-hospital mortality: 47%
- 1-year mortality: 68%
