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Tadphale SD, Luckett PM, Quigley RP, Dhar AV, Gollhofer DK, Modem V. Fluid Removal in Children on Continuous Renal Replacement Therapy Improves Organ Dysfunction Score. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0043-1764499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
AbstractThe objective is to assess impact of fluid removal on improvement in organ function in children who received continuous renal replacement therapy (CRRT) for management of acute kidney injury and/or fluid overload (FO). A retrospective review of eligible patients admitted to a tertiary level intensive care unit over a 3-year period was performed. Improvement in nonrenal organ function, the primary outcome, was defined as decrease in nonrenal component of Pediatric Logistic Organ Dysfunction (PELOD) score on day 3 of CRRT. The cohort was categorized into Group 1 (improvement) and Group 2 (no improvement or worsening) in nonrenal PELOD score. Multivariable logistic regression analysis was performed to identify independent predictors. A higher PELOD score at CRRT initiation (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.05, 1.18, p < 0.001), belonging to infant-age group (OR: 4.53, 95% CI: 4.40, 5.13, p = 0.02) and greater fluid removal during initial 3 days of CRRT (OR: 1.05, 95% CI: 1.01, 1.10, p = 0.01) were associated with an improvement in nonrenal PELOD score at day 3 of CRRT. FO at CRRT initiation (OR: 0.66, 95% CI: 0.46, 0.93, p = 0.02) and having an underlying oncologic diagnosis (OR: 0.28, 95% CI: 0.09, 0.85, p = 0.03) were associated with worsening of nonrenal PELOD score at day 3 of CRRT. Careful consideration of certain modifiable patient and/or fluid removal kinetic factors may have an impact on outcomes.
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Affiliation(s)
- Sachin D. Tadphale
- Division of Pediatric Cardiology & Critical Care Medicine, UTHSC, Memphis, Tennessee, United States
| | - Peter M. Luckett
- Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
| | | | - Archana V. Dhar
- Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
| | - Diane K. Gollhofer
- Division of Critical Care Services, Children's Health-Dallas, Dallas, Texas, United States
| | - Vinai Modem
- Pediatric Intensive Care Unit, Cook Children's Medical Center, Fort Worth, Texas, United States
- Department of Pediatrics, TCU and UNTHSC School of Medicine, Fort Worth, Texas, United States
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Kim DW, Jang GS, Jung KS, Jung HJ, Kim HJ, Rhee H, Seong EY, Song SH. Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy. Kidney Res Clin Pract 2022; 41:717-729. [PMID: 35977906 PMCID: PMC9731773 DOI: 10.23876/j.krcp.21.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Whether continuous renal replacement therapy (CRRT) should be applied to critically ill patients with both acute kidney injury (AKI) and cancer remains controversial because of poor expected outcomes. The present study determined prognostic factors for all-cause in-hospital mortality in patients with AKI and cancer undergoing CRRT. METHODS We included 471 patients with AKI and cancer who underwent CRRT at the intensive care unit of a Korean tertiary hospital from 2013 to 2020, and classified them by malignancy type. The primary outcomes were 28-day all-cause mortality rate and prognostic factors for in-hospital mortality. The secondary outcome was renal replacement therapy (RRT) dependency at hospital discharge. RESULTS The 28-day mortality rates were 58.8% and 82% in the solid and hematologic malignancy groups, respectively. Body mass index (BMI), presence of oliguria, Sequential Organ Failure Assessment (SOFA) score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups. A high heart rate and the presence of severe acidosis were prognostic factors only in the solid malignancy group. Among the survivors, the proportion with RRT dependency was 25.0% and 33.3% in the solid and hematologic malignancy groups, respectively. CONCLUSION The 28-day mortality rate of cancer patients with AKI undergoing CRRT was high in both the solid and hematologic malignancy groups. BMI, presence of oliguria, SOFA score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups, but a high heart rate and severe acidosis were prognostic factors only in the solid malignancy group.
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Affiliation(s)
- Da Woon Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Geum Suk Jang
- Department of Nursing, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoung Suk Jung
- Department of Nursing, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Harin Rhee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Critically ill cancer patient's resuscitation: a Belgian/French societies' consensus conference. Intensive Care Med 2021; 47:1063-1077. [PMID: 34545440 PMCID: PMC8451726 DOI: 10.1007/s00134-021-06508-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts' opinion and a final consensus conference about nine predefined questions1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be used to guide admission of cancer patient to intensive care units?2. Which ventilatory support [High Flow Oxygenation, Non-invasive Ventilation (NIV), Invasive Mechanical Ventilation (IMV), Extra-Corporeal Membrane Oxygenation (ECMO)] should be used, for which complications and in which environment?3. Which support should be used for extra-renal purification, in which conditions and environment?4. Which haemodynamic support should be used, for which complications, and in which environment?5. Which benefit of cardiopulmonary resuscitation in cancer patients and for which complications?6. Which intensive monitoring in the context of oncologic treatment (surgery, anti-cancer treatment …)?7. What specific considerations should be taken into account in the intensive care unit?8. Based on which criteria, in terms of benefit and complications and taking into account the neoplastic disease, patients hospitalized in an intensive care unit (or equivalent) should receive cellular elements derived from the blood (red blood cells, white blood cells and platelets)?9. Which training is required for critical care doctors in charge of cancer patients?
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Gudsoorkar P, Langote A, Vaidya P, Meraz-Muñoz AY. Acute Kidney Injury in Patients With Cancer: A Review of Onconephrology. Adv Chronic Kidney Dis 2021; 28:394-401.e1. [PMID: 35190106 DOI: 10.1053/j.ackd.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Abstract
Over the past 2 decades, significant research and advancements have been made in oncology and its therapeutics. Thanks to novel diagnostic methods, treatments, and supportive measures, patients with cancer live longer and have a better quality of life. However, an unforeseen consequence of this progress has been increasing medical complications, including acute kidney injury. The purpose of this review is to provide an overview of the epidemiology and most common causes of acute kidney injury in patients with cancer unrelated to oncological treatment.
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Meraz-Munoz A, Langote A, Jhaveri KD, Izzedine H, Gudsoorkar P. Acute Kidney Injury in the Patient with Cancer. Diagnostics (Basel) 2021; 11:611. [PMID: 33805529 PMCID: PMC8065801 DOI: 10.3390/diagnostics11040611] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/18/2023] Open
Abstract
Over the last three decades, advancements in the diagnosis, treatment, and supportive care of patients with cancer have significantly improved their overall survival. However, these advancements have also led to a higher rate of cancer-related complications. Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in patients with cancer, and they are associated with an increased risk of all-cause mortality. This bidirectional interplay between cancer and kidney, termed "the kidney-cancer connection" has become a very active area of research. This review aims to provide an overview of some of the most common causes of AKI in patients with cancer. Cancer therapy-associated AKI is beyond the scope of this review and will be discussed separately.
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Affiliation(s)
- Alejandro Meraz-Munoz
- Division of Nephrology, Department of Medicine, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
| | - Amit Langote
- Consultant Nephrologist, Apollo Hospital, Navi Mumbai, Maharashtra 400614, India;
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, NY 11021, USA;
| | - Hassane Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, 75013 Paris, France;
| | - Prakash Gudsoorkar
- Division of Nephrology & Kidney Clinical Advancement, Research & Education Program, University of Cincinnati, Cincinnati, OH 45267, USA
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Gorham J, Ameye L, Paesmans M, Berghmans T, Sculier JP, Meert AP. [Lung cancer: Prognosis in intensive care depends mainly on the acute complication]. Rev Mal Respir 2019; 36:333-341. [PMID: 30898468 DOI: 10.1016/j.rmr.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It has been demonstrated in unselected populations of cancer patients that prognosis in intensive care is essentially dependent on the extent of the acute physiological disturbance caused by the complication precipitating the admission. By contrast, the prognosis after hospital discharge remains dependent on the characteristics of the underlying neoplasm. The aim of our study was to confirm whether this general finding was the case in a specific population of lung cancer patients, since there are no data on this patient group in the literature. PATIENTS AND METHODS We conducted a retrospective study including all patients with lung cancer admitted to our ICU between September 1, 2008 and December 31, 2013. RESULTS During this period, 180 different patients with lung cancer were admitted into ICU. The simplified acute physiology score II (SAPS II) (OR 1.07 ; 95% CI 1.04-1.11), respiratory failure (OR 4.00; 95% CI 1.76-9.07) and the presence of therapeutic limitations were the 3 factors independently affecting hospital mortality in multivariate analysis. Considering only patients discharged alive from the hospital, the presence of metastases (HR 2.30; 95% CI 1.44-3.65) and limitations on therapy (HR 5,89; IC 95% 3,11-11,14) were the two statistically independent prognostic factors for overall survival. CONCLUSION In this population of lung cancer patients admitted into ICU, independent predictors of hospital mortality are determined by the physiological perturbations induced by the acute presenting complication. After recovery from this, prognosis is again determined by the characteristics of the underlying cancer.
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Affiliation(s)
- J Gorham
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique.
| | - L Ameye
- Data Centre, Institut Jules-Bordet, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - M Paesmans
- Data Centre, Institut Jules-Bordet, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - T Berghmans
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
| | - J-P Sculier
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
| | - A-P Meert
- Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique
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Ko H, Yan M, Gupta R, Kebbel K, Maiti A, Song J, Nates J, Overman MJ. Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit. Oncologist 2018; 24:483-490. [PMID: 30518614 DOI: 10.1634/theoncologist.2018-0328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions. PATIENTS AND METHODS The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival. RESULTS The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6-month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU. CONCLUSION For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long-term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication. IMPLICATIONS FOR PRACTICE Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.
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Affiliation(s)
- Heidi Ko
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melissa Yan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rohan Gupta
- Department of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kayla Kebbel
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Abhishek Maiti
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Nates
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wang T, Zhang Y, Li Q, Jia S, Shi C, Niu K, Liu B. Acute kidney injury in cancer patients and impedance cardiography-assisted renal replacement therapy: Experience from the onconephrology unit of a Chinese tertiary hospital. Exp Ther Med 2017; 14:5671-5677. [PMID: 29285109 DOI: 10.3892/etm.2017.5244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/27/2017] [Indexed: 01/14/2023] Open
Abstract
Acute kidney injury (AKI) in cancer patients may disrupt anticarcinogenic treatment and greatly increase associated mortality rates. The present study reported on the management of cancer patients with AKI and, from the nephrologic viewpoint, on the significance of fine volume control during the continuous renal replacement therapy (CRRT). The records of 117 cancer patients with AKI treated over three years were reviewed and their data were compared with those of 120 healthy controls. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria with serum creatinine levels determined on initial admission and for the diagnosis of AKI. CRRT with concomitant impedance cardiography (ICG) monitoring was performed in 79 patients. On average, AKI manifested as a 1.68±0.38-fold increase in serum creatinine within 10.2±5.7 days. The causes of AKI were diverse, with the major ones being nephrotoxic agents, hypotension and obstructive nephropathy. Renal biopsy confirmed two cases of thrombotic microangiopathy, due to the use of interfon-α and sunitinib malate, respectively, and a third case of cast nephropathy caused by immunoglobulin D multiple myeloma. The patients were generally marantic and had compromised cardiac function compared with the healthy controls. The CRRT prescription was discriminatingly optimized by the ICG parameters effecting discreet fluid balance, as the thoracic fluid content was significantly correlated with the ultrafiltration rate. By considering the causative mechanisms and applying subtle ICG-assisted volume control, the present study may thus help to improve the safety and efficacy of CRRT in cancer patients with AKI. In addition, it provided information to bring advances in onconephrology, a novel nephrological subspecialty field.
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Affiliation(s)
- Tao Wang
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yan Zhang
- Department of Dermatology, Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Qingxia Li
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Shumin Jia
- Hemodialysis Center, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Changjin Shi
- Department of Urology, Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Kai Niu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Bing Liu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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Fischler R, Meert AP, Sculier JP, Berghmans T. Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Cancer: A Well-Tolerated Adjunct Treatment. Front Med (Lausanne) 2016; 3:33. [PMID: 27536658 PMCID: PMC4972010 DOI: 10.3389/fmed.2016.00033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction Acute renal failure (ARF) has a poor prognosis in patients with cancer requiring intensive care unit (ICU) admission. Our aim is finding prognostic factors for hospital mortality in patients with cancer with ARF requiring renal replacement therapy (RRT). Methods In this retrospective study, all patients with cancer with ARF treated with continuous venovenous filtration (CVVHDF) in the ICU of the Institut Jules Bordet, between January 1, 2003 and December 31, 2012, were included. Results One hundred and three patients are assessed: men/women 69/34, median age 62 years, solid/hematologic tumors 68/35, median SAPS II 56. Mortality rate was 63%. Seven patients required chronic renal dialysis. After multivariate analysis, two variables were statistically associated with hospital mortality: more than one organ failure (including kidney) (OR 5.918; 95% CI 2.184–16.038; p < 0.001) and low albumin level (OR 3.341; 95% CI 1.229–9.077; p = 0.02). Only minor complications related to CVVHDF have been documented. Conclusion Despite the poor prognosis associated with ARF, CVVHDF is an effective and tolerable renal replacement technique in patients with cancer admitted to the ICU. Multiple organ failure and hypoalbuminemia, two independent prognostic factors for hospital mortality have to be considered when deciding for introducing RRT.
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Affiliation(s)
- Rebecca Fischler
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Anne-Pascale Meert
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Jean-Paul Sculier
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Thierry Berghmans
- Department of Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
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Meert AP, Berghmans T, Sculier JP. Admitting lung cancer patients to intensive care for organ dysfunction: a complex decision process. Eur Respir J 2016; 45:308-9. [PMID: 25653261 DOI: 10.1183/09031936.00198714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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11
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Toffart AC, Duruisseaux M, Sakhri L, Giaj Levra M, Moro-Sibilot D, Timsit JF. Indications de réanimation en oncologie thoracique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1877-1203(16)30039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Camus MF, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP. Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience. Support Care Cancer 2014; 23:1779-85. [PMID: 25471179 DOI: 10.1007/s00520-014-2524-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/14/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE The purposes of this study were to evaluate, in colorectal cancer patients, the cause of ICU admission and to find predictors of death during and after hospitalization. METHODS This is a retrospective study including all patients with colorectal cancer admitted in the ICU of a cancer hospital from January 1st 2003 to December 31 2012. RESULTS Among 3721 ICU admissions occurring during the study period, 119 (3.2 %) admissions dealt with colorectal cancer, of whom 89 were eligible and assessable. The main reasons for admission were of metabolic (24 %), hemodynamic (19 %), cardiovascular (18 %), gastrointestinal (16 %), respiratory (13 %), or neurologic (6 %) origin. These complications were due to cancer in 43 %, to the antineoplastic treatment in 25 %, or were unrelated to the cancer or its treatment in 33 %. A quarter of the patients died during hospitalization. Independent predictors of death were the Sequential Organ Failure Assessment (SOFA) score (with risk of dying increasing by 42 % per unit of SOFA score), fever (with risk of dying multiplied by three per °C), and high values of GOT (with risk of dying multiplied by 1 % per unit increase), while cancer control (i.e., stage progression or not), compliance to the initial cancer treatment plan, and LDH ≤ median levels had prognostic significance for further longer survival after hospital discharge. CONCLUSION This is the first study looking at specific causes for unplanned ICU admission of patients with colorectal cancer. Hospital mortality was influenced by the characteristics of the complication that entailed the ICU admission while cancer characteristics retained their prognostic influence on survival after hospital discharge.
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Affiliation(s)
- M F Camus
- Service des soins intensifs et urgences oncologiques and oncologie thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB), 1, rue Héger Bordet, 1000, Bruxelles, Belgium
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Prediction of short- and long-term survival for advanced cancer patients after ICU admission. Support Care Cancer 2014; 23:1647-55. [DOI: 10.1007/s00520-014-2519-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022]
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14
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Meert AP, Berghmans T, Sculier JP. [The patient with lung cancer in intensive care]. Rev Mal Respir 2014; 31:961-74. [PMID: 25496791 DOI: 10.1016/j.rmr.2014.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/28/2014] [Indexed: 12/17/2022]
Abstract
In Western countries, lung cancer (LC) is the most common cause of cancer death. It is present in 15-20% of patients admitted to the ICU with a neoplastic condition. The purpose of this article is to review the causes of admission to ICU of patients with LC, their prognosis and the results of different life-support techniques. Most studies include mixed populations of non-small cell (NSCLC) and small-cell lung cancers (SCLC). However, there is preponderance of NSCLC (70%) and LC of advanced or metastatic stages, reflecting the distribution in the general population of LC. The cause of admission of LC patients to ICU is most often of respiratory origin. The ICU mortality rate currently ranges from 13 to 47% and the hospital mortality rate from 24 to 65%. The predictors of in-hospital mortality are mainly severity scores, organ dysfunction, general condition (performance status), respiratory distress and the need for mechanical ventilation or vasopressor drugs. When considering the long-term mortality, it is the features of the cancer (presence of metastases, cancer progression) that are important predictive factors.
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Affiliation(s)
- A-P Meert
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique.
| | - T Berghmans
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
| | - J-P Sculier
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
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Lameire N, Van Biesen W, Vanholder R. Electrolyte disturbances and acute kidney injury in patients with cancer. Semin Nephrol 2011; 30:534-47. [PMID: 21146119 DOI: 10.1016/j.semnephrol.2010.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The interrelation between kidney disease and cancer is complex and reciprocal. Among the most frequent cancer-associated kidney diseases are the electrolyte and acid-base disturbances, which occur frequently and often are associated with an ominous prognosis, and acute kidney injury. Tumor lysis syndrome is a potentially life-threatening condition that frequently occurs in patients with a high tumor burden and high cellular turnover after cytotoxic therapy (including steroids in steroid-sensitive hematologic malignancies). Electrolyte and acid-base disturbances are the consequence of neoplastic spread, anticancer treatment, or, more rarely, paraneoplastic phenomena of all types of tumors. This article reviews hyponatremia and hypernatremia, hypokalemia and hyperkalemia, hypomagnesemia, hypercalcemia and hypocalcemia, hypophosphatemia, and the most important disturbances in acid-base balance in cancer patients. Acute kidney injury (AKI) is a frequent occurrence in cancer patients and has the potential to substantially alter the outcome of patients with cancer and jeopardize their chances of receiving optimal cancer treatment and a potential cure. As in many other circumstances, the etiology of AKI in cancer patients is multifactorial. Initiation and/or continuation of dialysis in the AKI cancer patient should be based on the general clinical condition and overall life expectancy and the personal patient expectations on quality of life after eventual recovery.
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McDowall KL, Hart AJ, Cadamy AJ. The Outcomes of Adult Patients with Haematological Malignancy Requiring Admission to the Intensive Care Unit. J Intensive Care Soc 2011. [DOI: 10.1177/175114371101200207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A literature review was conducted to ascertain the prognosis of patients with haematological malignancies admitted to the intensive care unit (ICU) and to identify any factors that could be shown to influence outcome. Studies that examined outcomes among patients with haematological malignancy admitted to ICU were evaluated. Pooled outcome data relating to ICU, hospital and six-month mortality were compiled. A qualitative assessment of the evidence relating to putative determinants of prognosis was made. Observational studies examining outcomes among over 10,000 haematological malignancy patients admitted to the ICU were identified. Approximately 40% of such patients survived until hospital discharge. The principle determinants of short-term survival would appear to be related to the severity of the acute illness and the consequent physiological derangement or organ system dysfunction. In the longer term, factors relating to the prognosis of the underlying malignancy appear to be important.
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Affiliation(s)
- Katherine L McDowall
- Department of Anaesthesia and Intensive Care Medicine, Southern General Hospital, Glasgow
| | - Alistair J Hart
- Department of Haematology, Western General Hospital, Edinburgh. Currently Victoria Hospital, Kirkaldy, Fife
| | - Andrew J Cadamy
- Consultant in Anaesthesia and Intensive Care, Southern General Hospital, Glasgow
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Santana Cabrera L, Sánchez-Palacios M, Villanueva Ortiz A, Martínez Cuéllar S. Pronóstico de los pacientes que precisaron técnicas continuas de reemplazamiento renal en una unidad de cuidados intensivos. Med Clin (Barc) 2011; 136:363-4. [DOI: 10.1016/j.medcli.2009.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 06/16/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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Maccariello E, Valente C, Nogueira L, Bonomo H, Ismael M, Machado JE, Baldotto F, Godinho M, Rocha E, Soares M. Outcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units. Nephrol Dial Transplant 2010; 26:537-43. [DOI: 10.1093/ndt/gfq441] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Admission criteria and prognostication in patients with cancer admitted to the intensive care unit. Crit Care Clin 2010; 26:1-20. [PMID: 19944273 DOI: 10.1016/j.ccc.2009.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Critical care for patients with cancer was once considered inappropriate because of a perceived poor prognosis for their long-term survival. Three decades of research has yielded evidence to support the use of critical care resources for many patients with cancer. A methodical approach to triage and evaluation of critically ill patients regardless of baseline medical diagnosis, coupled with an appreciation for the likely prognosis of their current cancer, is most likely to yield the fairest and most accurate appropriation of care. No clinical scoring system has emerged that accurately defines the severity of illness and likelihood for survival in patients with cancer. This article reviews the studies that have attempted to apply mortality prediction scales or scoring systems to these patients. Clinical judgment with incorporation of consensus opinions from the literature should be used to develop admission or restriction criteria for intensive care of patients with cancer.
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Benoit DD, Hoste EA. Acute Kidney Injury in Critically Ill Patients with Cancer. Crit Care Clin 2010; 26:151-79. [DOI: 10.1016/j.ccc.2009.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Sculier JP, Berghmans T, Meert AP. Les indications et les résultats des soins intensifs chez les patients atteints de cancer bronchique. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)78143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Soares M, Salluh JIF, Carvalho MS, Darmon M, Rocco JR, Spector N. Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 2006; 24:4003-10. [PMID: 16921054 DOI: 10.1200/jco.2006.05.7869] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the outcomes of critically ill patients with cancer and acute renal dysfunction. PATIENTS AND METHODS Prospective cohort study conducted at a 10-bed oncologic medical-surgical intensive care unit (ICU) over a 56-month period. RESULTS Of 975 patients, 309 (32%) had renal dysfunction and were studied. Their mean age was 60.9 +/- 15.9 years; 233 patients (75%) had solid tumors and 76 (25%) had hematologic malignancies. During the ICU stay, 98 patients (32%) received dialysis. Renal dysfunction was multifactorial in 56% of the patients, and the main associated factors were shock/ischemia (72%) and sepsis (63%). Overall hospital and 6-month mortality rates were 64% and 73%, respectively. Among patients who required dialysis, mortality rates were lower in patients who received dialysis on the first day of ICU in comparison with those who required it thereafter. In a multivariable Cox model, age more than 60 years, uncontrolled cancer, impaired performance status, and more than two associated organ failures were associated with increased 6-month mortality. Renal function was completely re-established in 82% and partially re-established in 12%, and only 6% of survivors required chronic dialysis. CONCLUSION Acute renal dysfunction is frequent in critically ill patients with cancer. Although mortality rates are high, selected patients can benefit from ICU care and advanced organ support. When evaluating prognosis and the appropriateness of dialysis in these patients, older age, functional capacity, cancer status and the severity of associated organ failures are important variables to take into consideration.
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Affiliation(s)
- Márcio Soares
- Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005; 118:827-32. [PMID: 16084171 DOI: 10.1016/j.amjmed.2005.01.069] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 12/28/2004] [Accepted: 01/04/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine mortality rates in patients with acute renal failure during the past decades. METHODS We performed a MEDLINE search using the keywords "acute renal failure" crossed with "outcome," "mortality," "ICU," "critically ill" or "prognosis" in the period from January 1970 to December 2004. Abstracts and full articles were eligible if mortality rates were reported. We also reviewed the bibliographies of available studies for further potentially eligible studies. The dates of the observation period for each study and not the publication dates were considered for the analysis, so the earliest data were from 1956. RESULTS Of 85 articles fulfilling the criteria, 5 were excluded because of duplicate publications using the same database, so that 80 were included in our review with a total of 15897 patients. Mortality rates in most studies exceeded 30%, and there was no consistent change over time. CONCLUSION Despite technical progress in the management of acute renal failure over the last 50 years, mortality rates seem to have remained unchanged at around 50%.
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Affiliation(s)
- Yvonne Patricia Ympa
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
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