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Torres VBL, Vassalo J, Silva UVA, Caruso P, Torelly AP, Silva E, Teles JMM, Knibel M, Rezende E, Netto JJS, Piras C, Azevedo LCP, Bozza FA, Spector N, Salluh JIF, Soares M. Outcomes in Critically Ill Patients with Cancer-Related Complications. PLoS One 2016; 11:e0164537. [PMID: 27764143 PMCID: PMC5072702 DOI: 10.1371/journal.pone.0164537] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. MATERIALS AND METHODS Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. RESULTS Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94-1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11-12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57-5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04-3.71), P = 0.038] were independently associated with in-hospital mortality. CONCLUSIONS The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
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Affiliation(s)
- Viviane B. L. Torres
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Vassalo
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pedro Caruso
- ICU, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - André P. Torelly
- Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Eliezer Silva
- ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcos Knibel
- Hospital São Lucas, Travessa Frederico Pamplona 32, Rio de Janeiro, Brazil
| | - Ederlon Rezende
- ICU, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - José J. S. Netto
- ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Rio de Janeiro, Brazil
| | | | | | - Fernando A. Bozza
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Nelson Spector
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jorge I. F. Salluh
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marcio Soares
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
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Torres VBL, Soares M. Patients with hematological malignancies admitted to intensive care units: new challenges for the intensivist. Rev Bras Ter Intensiva 2016; 27:193-5. [PMID: 26465241 PMCID: PMC4592109 DOI: 10.5935/0103-507x.20150040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Marcio Soares
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
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