Prognostic factors for cancer patient admitted to a medical intensive care unit

Clinical course and outcomes of cancer patients admitted in medical ICU with sepsis

Background and aims

Sepsis is not only a leading cause of intensive care unit (ICU) admission but also one of the variables which affect outcomes of cancer patients. We aimed to assess the clinical characteristics, clinical course, mortality and risk factors associated with 30-day mortality in medical oncology patients admitted in a multi-disciplinary medical ICU.

Methods

We conducted a retrospective analysis of 435 consecutive cancer patients admitted in medical ICU over a 28 months period. Patients were divided into two groups based on the presence of sepsis at the time of ICU admission. Data regarding baseline patient characteristics, clinical and laboratory data, need for organ support and 30-day mortality were collected. Sepsis patients were further classified as 30-day survivors and non-survivors and risk factors for mortality in these patients were determined.

Results

Overall 30-day mortality was 57.8%. It was significantly higher in sepsis group patients (73.9%) as compared to non-sepsis patients (46.6%) (p < 0.001). Most common reason for ICU admission in non-sepsis group was respiratory distress (51.4%) followed by altered sensorium (28.4%). Presence of metastasis [odds ratio, OR: 3.89 (95% confidence interval, CI: 1.536-9.901)], high lactate [OR: 1.374 (95% CI: 1.024-1.843)] and need of invasive mechanical ventilator (IMV) support [OR: 7.634 (95% CI: 2.519-23.256)] or vasopressor support [OR: 3.268 (95% CI: 1.179-9.090)] were directly associated with 30-day mortality.

Conclusion

Critically ill cancer patients admitted with sepsis had high mortality. Presence of metastasis, high lactate and need of IMV or vasopressor support was associated with worse prognosis in cancer patients admitted with sepsis in ICU.

Prevalence and factors associated with sepsis and septic shock in oncological patients in intensive therapy

OBJECTIVES

to analyze factors associated with sepsis and septic shock in cancer patients in the Intensive Care Unit.

METHODS

cross-sectional, retrospective study with a quantitative approach, with a sample of 239 patients in an oncology hospital. Secondary data from medical records were used. The outcome variable was "presence of sepsis and/or septic shock"; and exposures: sex, length of stay, origin, use of invasive procedures and primary tumor site. Descriptive, bivariate analyzes and multiple logistic regression models were performed.

RESULTS

the prevalence of sepsis was 95% CI: 14.7-24.7 and septic shock of 95% CI: 37.7-50.3. In the multiple analysis, sepsis and/or septic shock were associated with hospital stay longer than seven days, being from the Emergency Department, presence of invasive procedures and hematological site.

CONCLUSIONS

sepsis and/or septic shock in cancer patients were associated with clinical characteristics and health care factors.