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Padhi S, Shrestha P, Alamgeer M, Stevanovic A, Karikios D, Rajamani A, Subramaniam A. Oncology and intensive care doctors' perception of intensive care admission of cancer patients: A cross-sectional national survey. Aust Crit Care 2024; 37:520-529. [PMID: 38350752 DOI: 10.1016/j.aucc.2023.12.005] [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: 09/10/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Prognosis in oncology has improved with early diagnosis and novel therapies. However, critical illness continues to trigger clinical and ethical dilemmas for the treating oncology and intensive care unit (ICU) doctors. OBJECTIVES The objective of this study was to investigate the perceptions of oncology and ICU doctors in managing critically ill cancer patients. METHODS A cross-sectional web-based survey exploring the management of a fictitious acutely deteriorating case vignette with solid-organ malignancy. The survey weblink was distributed between May and July 2022 to all Australian oncology and ICU doctors via newsletters to the members of the Medical Oncology Group of Australia, the Australian and New Zealand Intensive Care Society, and the College of Intensive Care Medicine inviting them to participate. The weblink was active till August 2022. The six domains included patient prognostication, advanced care plan, collaborative management, legal/ethical/moral challenges, ICU referral, and protocol-based ICU admission. The outcomes were reported as the level of agreement between oncology and ICU doctors for each domain/question. RESULTS 184 responses (64 oncology and 120 ICU doctors) were analysed. Most respondents were specialists (78.1% [n = 50] oncology, 78.3% [n = 94] ICU doctors). Oncology doctors more commonly reported managing cancer patients with poor prognosis than ICU doctors (p < 0.001). Oncology doctors less commonly referred such patients for ICU admission (29.7% [n = 19] vs. 80.8% [n = 97], p < 0.001; odds ratio [OR] = 0.07; 95% confidence interval [CI]: 0.03-0.16) and infrequently encountered patients with prior goals of care (GOC) in medical emergency team escalations (40.6% [n = 26] vs. 86.7% [n = 104]; p < 0.001; OR = 0.06; 95% CI: 0.02-0.15; p < 0.001). Oncology doctors were less likely to discuss GOC during medical emergency team calls or within 24 h of ICU admission. More oncology doctors than ICU doctors thought that training rotation in the corresponding speciality group was beneficial (56.3% [n = 36] vs. 31.7% [n = 38]; p = 0.012; OR = 2.07; 95% CI: 1.02-4.23; p = 0.045). CONCLUSION Oncology doctors were less likely to encounter acute patient deterioration or establish timely GOC for such patients. Oncology doctors believed that an ICU rotation during their training may have helped manage challenging situations.
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Affiliation(s)
- Swarup Padhi
- Department of Intensive Care, Goulburn Valley Health, Shepparton, Victoria, Australia.
| | - Prajwol Shrestha
- Department of Medical Oncology, Calvary Mater Newcastle Hospital, NSW, Australia
| | - Muhammad Alamgeer
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Australia
| | - Amanda Stevanovic
- Department of Medical Oncology, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Arvind Rajamani
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Intensive Care, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia; Department of Intensive Care, Monash Health, Dandenong, Victoria, Australia; Peninsula Clinical School, Monash University, Frankston, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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AlSaied G, Lababidi H, AlHawdar T, AlZahrani S, AlMotairi A, AlMaani M. Outcome of Cancer Patients with an Unplanned Intensive Care Unit Admission: Predictors of Mortality and Long-term Survival. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:153-161. [PMID: 38764561 PMCID: PMC11098267 DOI: 10.4103/sjmms.sjmms_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/27/2023] [Accepted: 11/19/2023] [Indexed: 05/21/2024]
Abstract
Background Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes. Objective To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival. Methods This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated. Results The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively. Conclusion The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission.
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Affiliation(s)
- Ghiath AlSaied
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Hani Lababidi
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
- Department of Health Professions Education, MGH-Institute of Health Professions, Boston, MA, USA
| | - Taher AlHawdar
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Saud AlZahrani
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Abdullah AlMotairi
- Department of Critical Care, Suleiman AlHabib Hospital, Riyadh, Saudi Arabia
| | - Mohamad AlMaani
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
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García de Herreros M, Laguna JC, Padrosa J, Barreto TD, Chicote M, Font C, Grafiá I, Llavata L, Seguí E, Tuca A, Viladot M, Zamora-Martínez C, Fernández-Méndez S, Téllez A, Nicolás JM, Prat A, Castro-Rebollo P, Marco-Hernández J. Characterisation and Outcomes of Patients with Solid Organ Malignancies Admitted to the Intensive Care Unit: Mortality and Impact on Functional Status and Oncological Treatment. Diagnostics (Basel) 2024; 14:730. [PMID: 38611643 PMCID: PMC11011727 DOI: 10.3390/diagnostics14070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. METHODS Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. RESULTS 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. CONCLUSION Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality.
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Affiliation(s)
- Marta García de Herreros
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Juan Carlos Laguna
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Tanny Daniela Barreto
- Radiation Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain;
| | - Manoli Chicote
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ignacio Grafiá
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Lucía Llavata
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carles Zamora-Martínez
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Sara Fernández-Méndez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Adrián Téllez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Josep Maria Nicolás
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Aleix Prat
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pedro Castro-Rebollo
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Javier Marco-Hernández
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
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Rourke S, Paterson C. How Does Health-Related Quality of Life Change Over Time in Cancer Survivors Following an Admission to the Intensive Care Unit?: An Integrative Review. Cancer Nurs 2024; 47:100-111. [PMID: 36066345 DOI: 10.1097/ncc.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survivors account for 15% to 20% of all intensive care unit (ICU) admissions. In general ICU populations, patients are known to experience reduced health-related quality of life (HRQoL). However, little is known about HRQoL impacts among cancer survivors following a critical illness in ICU. OBJECTIVE The aim of this study was to critically synthesize the evidence to further understand the impact of a critical illness and ICU admission in cancer survivors. METHODS An integrative review was conducted and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Three electronic databases were searched (MEDLINE, CINAHL, and EMBASE) using keywords and Boolean logic. Quality appraisal, data extraction, and a narrative synthesis were completed for all included studies by 2 reviewers. RESULTS Eleven publications met inclusion criteria. Health-related quality-of-life domains most frequently reported in cancer survivors after discharge from ICU included the following: physical function limitations, physical symptoms, and anxiety/depression. CONCLUSIONS Health-related quality of life decreased immediately after the admission to ICU with a gradual increase in the 3 to 12 months following. Cancer survivors are vulnerable to physical limitations, pain, and social isolation after an admission to ICU. IMPLICATIONS FOR PRACTICE Cancer survivors who have been affected by a critical illness are at risk of reduced HRQoL after an admission to ICU. This integrative review will help clinicians and researchers to develop patient-centered models of care during the recovery of critical illness, which are currently lacking in service delivery.
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Affiliation(s)
- Shalyn Rourke
- Author Affiliations: Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group (Ms Rourke, Dr Paterson) and School of Nursing, Midwifery and Public Health (Ms Rourke, Dr Paterson), University of Canberra, Bruce; and Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Garran (Ms Rourke, Dr Paterson), Canberra, Australian Capital Territory, Australia; and Robert Gordon University, Aberdeen, Scotland, United Kingdom (Ms Rourke, Dr Paterson)
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Wei M, Huang M, Duan Y, Wang D, Xing X, Quan R, Zhang G, Liu K, Zhu B, Ye Y, Zhou D, Zhao J, Ma G, Jiang Z, Huang B, Xu S, Xiao Y, Zhang L, Wang H, Lin R, Ma S, Qiu Y, Wang C, Zheng Z, Sun N, Xian L, Li J, Zhang M, Guo Z, Tao Y, Zhang L, Zhou X, Chen W, Wang D, Chi J. Prognostic and risk factor analysis of cancer patients after unplanned ICU admission: a real-world multicenter study. Sci Rep 2023; 13:22340. [PMID: 38102299 PMCID: PMC10724261 DOI: 10.1038/s41598-023-49219-6] [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: 01/20/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
To investigate the occurrence and 90-day mortality of cancer patients following unplanned admission to the intensive care unit (ICU), as well as to develop a risk prediction model for their 90-day prognosis. We prospectively analyzed data from cancer patients who were admitted to the ICU without prior planning within the past 7 days, specifically between May 12, 2021, and July 12, 2021. The patients were grouped based on their 90-day survival status, and the aim was to identify the risk factors influencing their survival status. A total of 1488 cases were included in the study, with an average age of 63.2 ± 12.4 years. The most common reason for ICU admission was sepsis (n = 940, 63.2%). During their ICU stay, 29.7% of patients required vasoactive drug support (n = 442), 39.8% needed invasive mechanical ventilation support (n = 592), and 82 patients (5.5%) received renal replacement therapy. We conducted a multivariate COX proportional hazards model analysis, which revealed that BMI and a history of hypertension were protective factors. On the other hand, antitumor treatment within the 3 months prior to admission, transfer from the emergency department, general ward, or external hospital, high APACHE score, diagnosis of shock and respiratory failure, receiving invasive ventilation, and experiencing acute kidney injury (AKI) were identified as risk factors for poor prognosis within 90 days after ICU admission. The average length of stay in the ICU was 4 days, while the hospital stay duration was 18 days. A total of 415 patients died within 90 days after ICU admission, resulting in a mortality rate of 27.9%. We selected 8 indicators to construct the predictive model, which demonstrated good discrimination and calibration. The prognosis of cancer patients who are unplanned transferred to the ICU is generally poor. Assessing the risk factors and developing a risk prediction model for these patients can play a significant role in evaluating their prognosis.
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Affiliation(s)
- Miao Wei
- Department of Intensive Care Unit, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Mingguang Huang
- Department of Intensive Care Unit, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Yan Duan
- Department of Intensive Care Unit, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Donghao Wang
- Department of Intensive Care Unit, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xuezhong Xing
- Department of Intensive Care Unit, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Rongxi Quan
- Department of Intensive Care Unit, Cancer Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Guoxing Zhang
- Department of Intensive Care Unit, Gaoxin District of Jilin Cancer Hospital, Changchun, Jilin, China
| | - Kaizhong Liu
- Department of Intensive Care Unit, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Biao Zhu
- Department of Intensive Care Unit, Fudan University Affiliated Shanghai Cancer Hospital, Shanghai, China
| | - Yong Ye
- Department of Intensive Care Unit, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Dongmin Zhou
- Department of Intensive Care Unit, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Jianghong Zhao
- Department of Intensive Care Unit, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Gang Ma
- Department of Intensive Care Unit, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhengying Jiang
- Department of Intensive Care Unit, Chongqing University Cancer Hospital, Chongqing, Sichuan, China
| | - Bing Huang
- Department of Intensive Care Unit, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi, China
| | - Shanling Xu
- Department of Intensive Care Unit, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan, China
| | - Yun Xiao
- Department of Intensive Care Unit, Yunnan Cancer Hospital, Kunming, Yunnan, China
| | - Linlin Zhang
- Department of Intensive Care Unit, Anhui Province Cancer Hospital, Hefei, Anhui, China
| | - Hongzhi Wang
- Department of Intensive Care Unit, Beijing Cancer Hospital, Beijing, China
| | - Ruiyun Lin
- Department of Intensive Care Unit, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shuliang Ma
- Department of Intensive Care Unit, Jiangsu Cancer Hospital, Nanjing, Jiangsu, China
| | - Yu'an Qiu
- Department of Intensive Care Unit, Jiangxi Provincial Tumor Hospital, Nanchang, Jiangxi, China
| | - Changsong Wang
- Department of Intensive Care Unit, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Zhen Zheng
- Department of Intensive Care Unit, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Ni Sun
- Department of Intensive Care Unit, Huguang District of Jilin Cancer Hospital, Changchun, Jilin, China
| | - Lewu Xian
- Department of Intensive Care Unit, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ji Li
- Department of Intensive Care Unit, Hainan Cancer Hospital, Haikou, Hainan, China
| | - Ming Zhang
- Department of Intensive Care Unit, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Zhijun Guo
- Department of Intensive Care Unit, Shandong First Medical University Affiliated Tumor Hospital, Jinan, Shandong, China
| | - Yong Tao
- Department of Intensive Care Unit, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Li Zhang
- Department of Intensive Care Unit, Hubei Cancer Hospital, Wuhan, Hubei, China
| | - Xiangzhe Zhou
- Department of Intensive Care Unit, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, China
| | - Wei Chen
- Department of Intensive Care Unit, Beijing Shijitan Hospital (Capital Medical University Cancer Hospital), Beijing, China
| | - Daoxie Wang
- Department of Intensive Care Unit, Cancer Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Jiyan Chi
- Department of Intensive Care Unit, Tumor Hospital of Mudanjiang City, Mudanjiang, Heilongjiang, China
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Alamgeer M, Ling RR, Ueno R, Sundararajan K, Sundar R, Pilcher D, Subramaniam A. Frailty and long-term survival among patients in Australian intensive care units with metastatic cancer (FRAIL-CANCER study): a retrospective registry-based cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e675-e684. [PMID: 38042160 DOI: 10.1016/s2666-7568(23)00209-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Recent advances in cancer therapeutics have improved outcomes, resulting in increasing candidacy of patients with metastatic cancer being admitted to intensive care units (ICUs). A large proportion of patients also have frailty, predisposing them to poor outcomes, yet the literature reporting on this is scarce. We aimed to assess the impact of frailty on survival in patients with metastatic cancer admitted to the ICU. METHODS In this retrospective registry-based cohort study, we used data from the Australia and New Zealand Intensive Care Society Adult Patient (age ≥16 years) database to identify patients with advanced (solid and haematological cancer) and a documented Clinical Frailty scale (CFS) admitted to 166 Australian ICUs. Patients without metastatic cancer were excluded. We analysed the effect of frailty (CFS 5-8) on long-term survival, and how this effect changed in specific subgroups (cancer subtypes, age [<65 years or ≥65 years], and those who survived hospitalisation). Because estimates tend to cluster within centres and vary between them, we used Cox proportional hazards regression models with robust sandwich variance estimators to assess the effect of frailty on survival time up to 4 years after ICU admission between groups. FINDINGS Between Jan 1, 2018, and March 31, 2022, 30 026 patients were eligible, and after exclusions 21 174 patients were included in the analysis; of these, 6806 (32·1%) had frailty, and 11 662 (55·1%) were male, 9489 (44·8%) were female, and 23 (0·1%) were intersex or self-reported indeterminate sex. The overall survival was lower for patients with frailty at 4 years compared with patients without frailty (29·5% vs 10·9%; p<0·0001). Frailty was associated with shorter 4-year survival times (adjusted hazard ratio 1·52 [95% CI 1·43-1·60]), and this effect was seen across all cancer subtypes. Frailty was associated with shorter survival times in patients younger than 65 years (1·66 [1·51-1·83]) and aged 65 years or older (1·40 [1·38-1·56]), but its effects were larger in patients younger than 65 years (pinteraction<0·0001). Frailty was also associated with shorter survival times in patients who survived hospitalisation (1·49 [1·40-1·59]). INTERPRETATION In patients with metastatic cancer admitted to the ICU, frailty was associated with poorer long-term survival. Patients with frailty might benefit from a goal-concordant time-limited trial in the ICU and will need suitable post-intensive care supportive management. FUNDING None.
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Affiliation(s)
- Muhammad Alamgeer
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia; Department of Medical Oncology, Monash Health, Clayton, VIC, Australia.
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ryo Ueno
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Eastern Health, Box Hill, VIC, Australia
| | - Krishnaswamy Sundararajan
- Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ashwin Subramaniam
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia; Department of Intensive Care, Dandenong Hospital, Dandenong, VIC, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia
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7
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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DG Palliativmedizin]. Med Klin Intensivmed Notfmed 2023; 118:14-38. [PMID: 37285027 PMCID: PMC10244869 DOI: 10.1007/s00063-023-01016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
The integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S3 guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität und Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90471, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Deutschland
| | - Bernd Schucher
- Abteilung Pneumologie, LungenClinic Großhansdorf, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Universitätsmedizin Essen Ruhrlandklinik, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Universität zu Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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8
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Toffart AC, Gonzalez F, Hamidfar-Roy R, Darrason M. [ICU admission for cancer patients with respiratory failure: An ethical dilemma]. Rev Mal Respir 2023; 40:692-699. [PMID: 37659881 DOI: 10.1016/j.rmr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/06/2023] [Indexed: 09/04/2023]
Abstract
In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care. We will then consider how and when to initiate reflection leading to a reasonable decision for the patient.
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Affiliation(s)
- A-C Toffart
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France; Université Grenoble 1 U 823, institut pour l'avancée des biosciences, université Grenoble Alpes, Grenoble, France.
| | - F Gonzalez
- Unité de réanimation, département anesthésie-réanimation, institut Paoli-Calmettes, Marseille, France
| | - R Hamidfar-Roy
- Service hospitalo-universitaire de pneumologie et physiologie, pôle thorax et vaisseaux, centre hospitalier universitaire Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - M Darrason
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, Lyon, France; Institut de recherches philosophiques de Lyon, université Lyon 3, Lyon, France
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9
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Kim JS, Kim YJ, Kim YJ, Kim WY. Impact of Developing Dialysis-Requiring Acute Kidney Injury on Long-Term Mortality in Cancer Patients with Septic Shock. Cancers (Basel) 2023; 15:3619. [PMID: 37509280 PMCID: PMC10377237 DOI: 10.3390/cancers15143619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Considering recent advances in both cancer and sepsis management, we chose to evaluate the associated factors for occurrence of septic acute kidney injury in cancer patients using a nationwide population-based cohort data. (2) Methods: Using data from the National Health Insurance Service of Korea, adult cancer patients who presented to emergency departments with septic shock from 2009 to 2017 were analyzed. A Cox-proportional hazard model was conducted to evaluate the clinical effect of sepsis-related acute kidney injury requiring dialysis. (3) Results: Among 42,477 adult cancer patients with septic shock, dialysis-requiring acute kidney injury occurred in 5449 (12.8%). Recovery from dialysis within 30 days was 77.9% and, overall, 30-day and 2-year mortality rates were 52.1% and 85.1%, respectively. Oncologic patients with dialysis-requiring acute kidney injury frequently occurred in males and patients with hematologic cancer. A multivariate Cox-proportional hazard model showed that dialysis-requiring acute kidney injury had the highest adjusted hazard ratio of 1.353 (95% confidence interval 1.313-1.395) for 2-year mortality. (4) Conclusions: Dialysis-requiring septic acute kidney injury did not occur commonly. However, it had a significant association with increased long-term mortality, which suggests emphasis should be placed on the prevention of acute kidney injury, particularly in male hematologic cancer patients.
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Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
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10
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Cantón-Bulnes ML, Jiménez-Sánchez M, Alcántara-Carmona S, Gimeno-Costa R, Berezo-García JÁ, Beato C, Álvarez-Lerma F, Mojal S, Olaechea P, Gordo-Vidal F, Garnacho-Montero J. Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study. Med Intensiva 2022; 46:669-679. [PMID: 36442913 DOI: 10.1016/j.medine.2021.08.019] [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: 03/05/2021] [Accepted: 08/07/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN An observational study was carried out. SETTING A total of 123 Intensive Care Units across Spain. PATIENTS All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS None. MAIN VARIABLES Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.
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Affiliation(s)
- M L Cantón-Bulnes
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - M Jiménez-Sánchez
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain
| | | | - R Gimeno-Costa
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Á Berezo-García
- Intensive Care Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - C Beato
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - F Álvarez-Lerma
- Intensive Care Unit, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
| | - S Mojal
- Bioestadístico, Barcelona, Spain
| | - P Olaechea
- Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain
| | - F Gordo-Vidal
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - J Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain
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11
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A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs. Crit Care Explor 2022; 4:e0757. [PMID: 36119395 PMCID: PMC9473777 DOI: 10.1097/cce.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The reported mortality rates of cancer patients admitted to ICUs vary widely. In addition, there are no studies that examined the outcomes of critically ill cancer patients based on the geographical regions. Therefore, we aimed to evaluate the mortality rates among critically ill cancer patients and provide a comparison based on geography.
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12
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Rosner MH, Darmon M, Ostermann M. Onco-nephrology: what the intensivist needs to know. Intensive Care Med 2022; 48:1234-1236. [PMID: 35943571 DOI: 10.1007/s00134-022-06840-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health, Charlottesville, VA, 22908, USA
| | - Michael Darmon
- Medical Intensive Care Unit, Hôpital Saint-Louis, Université Paris Cité, Paris, France.,Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, CRESS, INSERM, Paris, France
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Hospital, London, SE1 7EH, UK.
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13
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Trends in Hospital Admissions Due to Neoplasms in England and Wales between 1999 and 2019: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138054. [PMID: 35805710 PMCID: PMC9265694 DOI: 10.3390/ijerph19138054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 12/20/2022]
Abstract
Objectives: This study aimed to investigate the trends in neoplasm-related hospital admissions (NRHA) in England and Wales between 1999 and 2019. Methods: This is an ecological study using publicly available data taken from the two main medical databases in England and Wales; the Hospital Episode Statistics database in England and the Patient Episode Database in Wales. Hospital admissions data were collected for the period between April 1999 and March 2019. Results: A total of 35,704,781 NRHA were reported during the study period. Females contributed to 50.8% of NRHA. The NRHA rate among males increased by 50.0% [from 26.62 (95% CI 26.55−26.68) in 1999 to 39.93 (95% CI 39.86−40.00) in 2019 per 1000 persons, trend test, p < 0.001]. The NRHA rate among females increased by 44.1% [from 27.25 (95% CI 27.18−27.31) in 1999 to 39.25 (95% CI 39.18−39.32) in 2019 per 1000 persons, trend test, p < 0.001]. Overall, the rate of NRHA rose by 46.2% [from 26.93 (95% CI 26.89−26.98) in 1999 to 39.39 (95% CI 39.34−39.44) in 2019 per 1000 persons, trend test, p < 0.001]. Conclusion: Hospital admission rates due to neoplasms increased between 1999 and 2019. Our study demonstrates a variation in NRHA influenced by age and gender. Further observational studies are needed to identify other factors associated with increased hospital admissions among patients with different types of neoplasms.
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14
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Shen CI, Yang SY, Chiu HY, Chen WC, Yu WK, Yang KY. Prognostic factors for advanced lung cancer patients with do-not-intubate order in intensive care unit: a retrospective study. BMC Pulm Med 2022; 22:245. [PMID: 35751074 PMCID: PMC9229461 DOI: 10.1186/s12890-022-02042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background The survival of patients with lung cancer undergoing critical care has improved. An increasing number of patients with lung cancer have signed a predefined do-not-intubate (DNI) order before admission to the intensive care unit (ICU). These patients may still be transferred to the ICU and even receive non-invasive ventilation (NIV) support. However, there is still a lack of prognostic predictions in this cohort. Whether patients will benefit from ICU care remains unclear. Methods We retrospectively collected data from patients with advanced lung cancer who had signed a DNI order before ICU admission in a tertiary medical center between 2014 and 2016. The clinical characteristics and survival outcomes were discussed. Results A total of 140 patients (median age, 73 years; 62.1% were male) were included, had been diagnosed with stage III or IV non-small cell lung cancer (NSCLC) (AJCC 7th edition), and signed a DNI. Most patients received NIV during ICU stay. The median APACHE II score was 14 (standard error [SE], ± 0.66) and the mean PaO2/FiO2 ratio (P/F ratio) was 174.2 (SD, ± 104 mmHg). The APACHE II score was significantly lower in 28-day survivors (survivor: 12 (± 0.98) vs. non-survivor: 15 (± 0.83); p = 0.019). The P/F ratio of the survivors was higher than that of non-survivors (survivors: 209.6 ± 111.4 vs. non-survivors: 157.9 ± 96.7; p = 0.006). Patients with a P/F ratio ≥ 150 had better 28-day survival (p = 0.005). By combining P/F ratio ≥ 150 and APACHE II score < 16, those with high P/F ratios and low APACHE II scores during ICU admission had a notable 28-day survival compared with the rest (p < 0.001). These prognostic factors could also be applied to 90-day survival (p = 0.003). The prediction model was significant for those with driver mutations in 90-day survival (p = 0.021). Conclusions P/F ratio ≥ 150 and APACHE II score < 16 were significant prognostic factors for critically ill patients with lung cancer and DNI. This prediction could be applied to 90-day survival in patients with driver mutations. These findings are informative for clinical practice and decision-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02042-7.
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Affiliation(s)
- Chia-I Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan
| | - Shan-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Hwa-Yen Chiu
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan.,Department of Internal Medicine, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan.,Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan
| | - Wen-Kuang Yu
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan. .,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan. .,Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan. .,Cancer Progression Research Center, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan.
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15
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Fernández Ros N, Alegre F, Rodríguez Rodriguez J, Landecho MF, Sunsundegui P, Gúrpide A, Lecumberri R, Sanz E, García N, Quiroga J, Lucena JF. Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit. J Clin Med 2022; 11:jcm11123472. [PMID: 35743544 PMCID: PMC9225024 DOI: 10.3390/jcm11123472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75−391.25) days (patients with DNR orders 46 days (19.5−92.25), patients without DNR orders 162 days (39.5−632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3−4 vs. 0−2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.
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Affiliation(s)
- Nerea Fernández Ros
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Correspondence: ; Tel.: +34-948-296635; Fax: +34-948-296500
| | - Félix Alegre
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | | | - Manuel F. Landecho
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Patricia Sunsundegui
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | - Alfonso Gúrpide
- Department of Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.R.R.); (A.G.)
| | - Ramón Lecumberri
- Hematology Service, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Eva Sanz
- Faculty of Medicine, European University of Madrid, 28670 Madrid, Spain;
| | - Nicolás García
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Jorge Quiroga
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 28801 Madrid, Spain
| | - Juan Felipe Lucena
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
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Molecular Mechanisms and Biomarkers Associated with Chemotherapy-Induced AKI. Int J Mol Sci 2022; 23:ijms23052638. [PMID: 35269781 PMCID: PMC8910619 DOI: 10.3390/ijms23052638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022] Open
Abstract
Acute kidney injury (AKI) is a life-threatening condition characterized by a rapid and transient decrease in kidney function. AKI is part of an array of conditions collectively defined as acute kidney diseases (AKD). In AKD, persistent kidney damage and dysfunction lead to chronic kidney disease (CKD) over time. A variety of insults can trigger AKI; however, chemotherapy-associated nephrotoxicity is increasingly recognized as a significant side effect of chemotherapy. New biomarkers are urgently needed to identify patients at high risk of developing chemotherapy-associated nephrotoxicity and subsequent AKI. However, a lack of understanding of cellular mechanisms that trigger chemotherapy-related nephrotoxicity has hindered the identification of effective biomarkers to date. In this review, we aim to (1) describe the known and potential mechanisms related to chemotherapy-induced AKI; (2) summarize the available biomarkers for early AKI detection, and (3) raise awareness of chemotherapy-induced AKI.
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Hong Y, Hong JY, Park J. Differences in ICU Outcomes According to the Type of Anticancer Drug in Lung Cancer Patients. Front Med (Lausanne) 2022; 9:824266. [PMID: 35237632 PMCID: PMC8882653 DOI: 10.3389/fmed.2022.824266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeWe investigated the intensive care unit (ICU) outcomes of patients who used targeted therapy compared to those who received cytotoxic chemotherapy.Materials and MethodsThis study was based on Korean administrative health insurance claims from 2015 to 2019. We extracted data on lung cancer patients (>18 years old) who were admitted to the ICU after receiving chemotherapy.Results6,930 lung cancer patients who received chemotherapy within 30 days before ICU admission were identified; the patients received cytotoxic chemotherapy (85.4%, n = 5,919) and molecular targeted therapy (14.5%, n = 1,011). Grade 4 neutropenia was identified only in the cytotoxic chemotherapy group (0.6%). Respiratory failure requiring ventilator treatment was more common in the cytotoxic chemotherapy group than in the targeted therapy group (HR, 3.30; 95% CI, 2.99–3.63), and renal failure requiring renal replacement therapy was not significantly different between the two groups (HR, 1.57; 95% CI, 1.36–1.80). Patients who received targeted chemotherapy stayed longer in the ICU than the cytotoxic chemotherapy. The 28-day mortality was 23.4% (HR, 0.79; 95% CI, 0.67–0.90, p < 0.05) among patients who received targeted agents compared with 29.6% among patients who received cytotoxic chemotherapy.ConclusionTargeted chemotherapy for lung cancer may contribute to increasing access to critical care for lung cancer patients, which may play a role in improving critical care outcomes of lung cancer patients.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Ji Young Hong
- Department of Internal Medicine, Hanlym University Chuncheon Hospital, Chuncheon, South Korea
| | - Jinkyeong Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- *Correspondence: Jinkyeong Park
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Cobert J, Cook AC, Lin JA, O'Riordan DL, Pantilat SZ. Trends in Palliative Care Consultations in Critically Ill Patient Populations, 2013-2019. J Pain Symptom Manage 2022; 63:e176-e181. [PMID: 34348177 DOI: 10.1016/j.jpainsymman.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Critically ill patients have important palliative care (PC) needs in the intensive care unit (ICU), but specialty PC is often underutilized. OBJECTIVE To evaluate changes in utilization and reasons for PC consultation over time. METHODS Data from a national multi-site network of inpatient PC visits were used to identify patients age ≥18 years admitted to an ICU between 2013 and 2019. Year of ICU admission was the exposure. Primary diagnosis and reason for referral were identified by standardized process measures within the dataset at the time of referral. Trends in primary diagnosis and reason for referral were modeled as a function of year of ICU admission. RESULTS Across 39,515 ICU patients seen by a PC team, overall numbers of consultations from the ICU increased each year. Referrals for patients with cancer decreased from 17.6% (95% CI 13.7%-21.5%) to 14.3% (95% CI 13.2%-14.7%) and for patients with cardiovascular disease increased from 16.8% in (95% CI 16.8%-16.9%) to 18.8% (95% CI 18.8%-18.9%). Reasons for referrals were primarily for goals of care and advance care planning and increased from 74.0% (95% CI 70.0%-78.0%) in 2013 to 80.0% (95% CI 79.4%-80.0%) in 2019 (P < 0.0001 for all trends). CONCLUSION PC referrals in ICU patients with cancer are decreasing, while those for cardiovascular disease are increasing. Reasons for referrals in the ICU are commonly for goals of care; other reasons, like pain control are uncommon. Early goals of care conversations and further training in advance care planning should be emphasized in the ICU setting.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service (J.C.), San Francisco VA Health Care System, San Francisco, CA, USA; Department of Anesthesiology (J.C.), University of California San Francisco, San Francisco, CA, USA.
| | - Allyson C Cook
- Division of Palliative Medicine (A.C.C., J.A.L., D.L.O., S.Z.P.), Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, CA, USA; Critical Care Medicine (A.C.C.), Department of Anesthesia, University of California San Francisco
| | - Joseph A Lin
- Division of Palliative Medicine (A.C.C., J.A.L., D.L.O., S.Z.P.), Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, CA, USA
| | - David L O'Riordan
- Division of Palliative Medicine (A.C.C., J.A.L., D.L.O., S.Z.P.), Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine (A.C.C., J.A.L., D.L.O., S.Z.P.), Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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19
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Hong Y, Kim WJ, Hong JY, Jeong YJ, Park J. A comprehensive analysis of 5-year outcomes in patients with cancer admitted to intensive care units. Tuberc Respir Dis (Seoul) 2022; 85:195-201. [PMID: 35045687 PMCID: PMC8987664 DOI: 10.4046/trd.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data. Methods All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality. Results Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87–1.94) for lung cancer; 1.44 (1.43–1.46) for other solid cancers; and 3.05 (2.95–3.16) for hematologic malignancies. Conclusion This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon 24253, Republic of Korea
| | - Yun-Jeong Jeong
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Jinkyeong Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
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Siddiqui SS, Narkhede AM, Chaudhari HK, Ravisankar NP, Dhundi U, Sarode S, Divatia JV, Kulkarni AP. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2022; 25:1421-1426. [PMID: 35027804 PMCID: PMC8693110 DOI: 10.5005/jp-journals-10071-24052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Critically ill solid organ malignancy patients admitted to intensive care unit (ICU) as unplanned medical admissions behave differently from other subsets of cancer patients (hematolymphoid malignancies and cancer patients admitted for postoperative care). These patients if appropriately selected may benefit from the ICU care. There is paucity of data on critically ill unplanned admissions of solid organ malignancies from South Asia. We analyzed data of patients with solid tumors with unplanned admissions to the ICU to determine the clinical, epidemiological characteristics, and predictors of hospital mortality in an Indian ICU. MATERIALS AND METHODS This prospective, observational study was done in our 14-bedded mixed medical-surgical ICU from July 2014 to November 2015. We included all consecutive adult unplanned admissions with solid organ malignancies having ICU stay of >24 hours. Surgical admissions, hematolymphoid malignancies, advanced malignancy with no treatment options, and those cured of cancer >5 years were excluded. RESULTS Two hundred and thirty-five consecutive patients were included in this cohort. ICU and hospital mortalities were 36.6 and 40%, respectively. On multivariate analysis, cancer status [odds ratio (OR): 3.204; 95% confidence interval (CI): 1.271-8.078], invasive mechanical ventilation (OR: 5.940; 95% CI: 2.632-13.408), and sequential organ failure assessment (SOFA) score on the day of ICU admission (OR: 1.199; 95% CI: 1.042-1.379) were independent predictors of hospital mortality. CONCLUSION Acute respiratory failure and septic shock are the common reasons of unplanned ICU admission for patients with solid organ malignancies. With good patient selection, more than half of such patients are likely to be discharged alive from the hospital. HOW TO CITE THIS ARTICLE Siddiqui SS, Narkhede AM, Chaudhari HK, Ravisankar NP, Dhundi U, Sarode S, et al. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2021;25(12):1421-1426.
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Affiliation(s)
- Suhail S Siddiqui
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amit M Narkhede
- Department of Critical Care Medicine, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Harish K Chaudhari
- Department of Critical Care Medicine, Arneja Heart and Multispeciality Hospital, Nagpur, Maharashtra, India
| | - Natesh Prabu Ravisankar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Ujwal Dhundi
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Satish Sarode
- VishwaRaj Super Speciality Hospital, Pune, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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21
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Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment. Ann Intensive Care 2021; 11:182. [PMID: 34951668 PMCID: PMC8709803 DOI: 10.1186/s13613-021-00968-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Major therapeutic advances including immunotherapy and targeted therapies have been changing the face of oncology and resulted in improved prognosis as well as in new toxic complications. The aim of this study is to appraise the trends in intensive care unit (ICU) admissions and outcomes of critically ill patients with solid malignancies. We performed a retrospective single-centre study over a 12-year period (2007–2018) including adult patients with solid malignancies requiring unplanned ICU admission. Admission patterns were classified as: (i) specific if directly related to the underlying cancer; (ii) non-specific; (iii) drug-related or procedural adverse events. Results 1525 patients were analysed. Lung and gastro-intestinal tract accounted for the two main tumour sites. The proportion of patients with metastatic diseases increased from 48.6% in 2007–2008 to 60.2% in 2017–2018 (p = 0.004). Critical conditions were increasingly related to drug- or procedure-related adverse events, from 8.8% of ICU admissions in 2007–2008 to 16% in 2017–2018 (p = 0.01). The crude severity of critical illness at ICU admission did not change over time. The ICU survival rate was 77.4%, without any significant changes over the study period. Among the 1279 patients with complete follow-up, the 1-year survival rate was 33.2%. Independent determinants of ICU mortality were metastatic disease, cancer in progression under treatment, admission for specific complications and the extent of organ failures (invasive and non-invasive ventilation, inotropes/vasopressors, renal replacement therapy and SOFA score). One-year mortality in ICU-survivors was independently associated with lung cancer, metastatic disease, cancer in progression under treatment, admission for specific complications and decision to forgo life-sustaining therapies. Conclusion Advances in the management and the prognosis of solid malignancies substantially modified the ICU admission patterns of cancer patients. Despite underlying advanced and often metastatic malignancies, encouraging short-term and long-term outcomes should help changing the dismal perception of critically ill cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00968-5.
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22
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van der Zee EN, Termorshuizen F, Benoit DD, de Keizer NF, Bakker J, Kompanje EJO, Rietdijk WJR, Epker JL. One-year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands. J Intensive Care Med 2021; 37:1165-1173. [PMID: 34787492 PMCID: PMC9396560 DOI: 10.1177/08850666211054369] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: A decrease in short-term mortality of critically ill
cancer patients with an unplanned intensive care unit (ICU) admission has been
described. Few studies describe a change over time of 1-year mortality.
Therefore, we examined the 1-year mortality of cancer patients (hematological or
solid) with an unplanned ICU admission and we described whether the mortality
changed over time. Methods: We used the National Intensive Care
Evaluation (NICE) registry and extracted all patients with an unplanned ICU
admission in the Netherlands between 2008 and 2017. The primary outcome was
1-year mortality, analyzed with a mixed-effects Cox proportional hazard
regression. We compared the 1-year mortality of cancer patients to that of
patients without cancer. Furthermore, we examined changes in mortality over the
study period. Results: We included 470,305 patients: 10,401 with
hematological cancer, 35,920 with solid cancer, and 423,984 without cancer. The
1-year mortality rates were 60.1%, 46.2%, and 28.3% respectively
(P< .01). Approximately 30% of the cancer patients
surviving their hospital admission died within 1 year, this was 12% in patients
without cancer. In hematological patients, 1-year mortality decreased between
2008 and 2011, after which it stabilized. In solid cancer patients, inspection
showed neither an increasing nor decreasing trend over the inclusion period. For
patients without cancer, 1-year mortality decreased between 2008 and 2013, after
which it stabilized. A clear decrease in hospital mortality was seen within all
three groups. Conclusion: The 1-year mortality of cancer patients
with an unplanned ICU admission (hematological and solid) was higher than that
of patients without cancer. About one-third of the cancer patients surviving
their hospital admission died within 1 year after ICU admission. We found a
decrease in 1-year mortality until 2011 in hematology patients and no decrease
in solid cancer patients. Our results suggest that for many cancer patients, an
unplanned ICU admission is still a way to recover from critical illness, and it
does not necessarily lead to success in long-term survival. The underlying type
of malignancy is an important factor for long-term outcomes in patients
recovering from critical illness.
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Affiliation(s)
| | - Fabian Termorshuizen
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands.,Amsterdam University Medical Center, Amsterdam Public Health research institute, 213752University of Amsterdam, Amsterdam, the Netherlands
| | | | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands.,Amsterdam University Medical Center, Amsterdam Public Health research institute, 213752University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Bakker
- 6993Erasmus University Medical Center, Rotterdam, the Netherlands.,5894New York University, New York, USA.,21611Columbia University Medical Center, New York, USA.,28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Wim J R Rietdijk
- 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jelle L Epker
- 6993Erasmus University Medical Center, Rotterdam, the Netherlands
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Peng X, Huang Y, Fu H, Zhang Z, He A, Luo R. Prognostic Value of Blood Urea Nitrogen to Serum Albumin Ratio in Intensive Care Unit Patients with Lung Cancer. Int J Gen Med 2021; 14:7349-7359. [PMID: 34737629 PMCID: PMC8560134 DOI: 10.2147/ijgm.s337822] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background We aimed to evaluate the prognostic ability of blood urea nitrogen (BUN) to serum albumin ratio (BAR) to predict in-hospital mortality in patients with lung cancer in the intensive care unit (ICU). Methods Medical Information Mart for Intensive Care IV (MIMIC-IV v1.0) database was used to identify patients who were diagnosed with lung cancer. The primary outcome was in-hospital mortality. Multivariate COX regression was used to investigate the association between BAR and in-hospital mortality and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were also used to ensure the robustness of our findings. eICU-CRD database (validation cohort) was also applied to validate our findings. Results The optimal cut-off value for BAR was 6.8mg/g. Among 1202 patients who were diagnosed with lung cancer, 287 high-BAR group (≥6.8mg/g) patients and 287 low-BAR group (<6.8mg/g) patients, who had similar propensity scores were included in this study. After matching, the high-BAR group had significantly higher in-hospital mortality (hazard ratio, HR, 2.24, 95% confidence index, 95% CI, 1.57–3.19, P<0.001) even after adjustment for confounding factors. Moreover, the performance of BAR was superior to that of BUN and serum albumin alone and could add net benefit in predicting in-hospital mortality. Those results were further confirmed in the validation cohort. Conclusion As an easily accessible and cost-effective parameter, BAR could serve as a good prognostic predictor for lung cancer patients in ICU.
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Affiliation(s)
- Xiulan Peng
- Department of Oncology, The Second Affiliated Hospital of Jianghan University, Wuhan, Hubei, People's Republic of China
| | - Yali Huang
- Department of Oncology, The Second Affiliated Hospital of Jianghan University, Wuhan, Hubei, People's Republic of China
| | - Haifeng Fu
- Department of Hepatopancreatobiliary Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Wuhan, Hubei, People's Republic of China
| | - Zhi Zhang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Jianghan University, Wuhan, Hubei, People's Republic of China
| | - Anbing He
- Department of Oncology, The Second Affiliated Hospital of Jianghan University, Wuhan, Hubei, People's Republic of China
| | - Renfeng Luo
- Department of Diagnostics, JiangHan University, Wuhan, Hubei, People's Republic of China
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Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Oud L. Critical illness in patients with metastatic cancer: a population-based cohort study of epidemiology and outcomes. J Investig Med 2021; 70:820-828. [PMID: 34535559 DOI: 10.1136/jim-2021-002032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
The appropriateness of intensive care unit (ICU) admission of patients with metastatic cancer remains debated. We aimed to examine the short-term outcomes and their temporal pattern in critically ill patients with metastatic disease. We used state-wide data to identify hospitalizations aged ≥18 years with metastatic cancer admitted to ICU in Texas during 2010-2014. Multivariable logistic regression modeling was used to examine the factors associated with short-term mortality and its temporal trends among all ICU admissions and those undergoing mechanical ventilation. Among 136,644 ICU admissions with metastatic cancer, 50.8% were aged ≥65 years, with one or more organ failures present in 53.3% and mechanical ventilation was used in 11.1%. The crude short-term mortality among all ICU admissions and those mechanically ventilated was 28.1% and 62.0%, respectively. Discharge to home occurred in 57.1% of all ICU admissions. On adjusted analyses, short-term mortality increased with rising number of organ failures (adjusted OR (aOR) 1.399, 95% CI 1.374 to 1.425), while being lower with chemotherapy (aOR 0.467, 95% CI 0.432 to 0.506) and radiation therapy (aOR 0.832, 95% CI 0.749 to 0.924), and decreased over time (aOR 0.934 per year, 95% CI 0.924 to 0.945). Predictors of short-term mortality were largely similar among those undergoing mechanical ventilation. Most ICU admissions with metastatic cancer survived hospitalization, although short-term mortality was very high among those undergoing mechanical ventilation. Short-term mortality decreased over time and was lower among those receiving chemotherapy and radiation therapy. These findings support consideration of critical care in patients with metastatic cancer, but underscore the need to address patient-centered goals of care ahead of ICU admission.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Kang JH, Swisher CB, Buckley ED, Herndon JE, Lipp ES, Kirkpatrick JP, Desjardins A, Friedman HS, Johnson MO, Randazzo DM, Ashley DM, Peters KB. Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis. CNS Oncol 2021; 10:CNS77. [PMID: 34545753 PMCID: PMC8461751 DOI: 10.2217/cns-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Methods: Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Results: Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care. Purpose: Data are lacking regarding outcomes of patients with primary brain tumors (PBTs) admitted to an intensive care unit (ICU), which may it difficult for ICU providers to know who of these patients will best benefit from ICU-level care. We aimed to describe our patient population to contribute to the limited data. Methods: We performed a retrospective analysis of critically ill PBT patients in our ICU. Results: Of 59 patients analyzed, ICU mortality was 19% (11/59), and the most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies.
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Affiliation(s)
- Jennifer H Kang
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Evan D Buckley
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - James E Herndon
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Eric S Lipp
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - John P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - Annick Desjardins
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Henry S Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Margaret O Johnson
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Dina M Randazzo
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - David M Ashley
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.,Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
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Toffart AC, Gonzalez F, Pierret T, Gobbini E, Terzi N, Moro-Sibilot D, Darrason M. Quels malades peuvent et doivent aller en réanimation ? REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2021; 13:2S244-2S251. [PMID: 34659596 PMCID: PMC8512108 DOI: 10.1016/s1877-1203(21)00116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A.-C. Toffart
- UM Oncologie Thoracique, Service Hospitalo-Universitaire de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble 1 U 823-Institut pour l’Avancée des Biosciences-Université Grenoble Alpes, Grenoble, France
- Auteur correspondant. Adresse e-mail : (A.-C. Toffart)
| | - F. Gonzalez
- Unité de réanimation, Département Anesthésie-Réanimation, Institut Paoli Calmettes, Marseille, France
| | - T. Pierret
- UM Oncologie Thoracique, Service Hospitalo-Universitaire de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - E. Gobbini
- UM Oncologie Thoracique, Service Hospitalo-Universitaire de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - N. Terzi
- UM Médecine Intensive Réanimation, Pôle Urgences Médecine Aiguë, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - D. Moro-Sibilot
- UM Oncologie Thoracique, Service Hospitalo-Universitaire de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble 1 U 823-Institut pour l’Avancée des Biosciences-Université Grenoble Alpes, Grenoble, France
| | - M. Darrason
- Service de Pneumologie aigue spécialisée et cancérologie thoracique, Centre Hospitalier Lyon Sud, Lyon, France
- Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France
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van der Zee EN, Benoit DD, Hazenbroek M, Bakker J, Kompanje EJO, Kusadasi N, Epker JL. Outcome of cancer patients considered for intensive care unit admission in two university hospitals in the Netherlands: the danger of delayed ICU admissions and off-hour triage decisions. Ann Intensive Care 2021; 11:125. [PMID: 34379217 PMCID: PMC8357904 DOI: 10.1186/s13613-021-00898-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background Very few studies assessed the association between Intensive Care Unit (ICU) triage decisions and mortality. The aim of this study was to assess whether an association could be found between 30-day mortality, and ICU admission consultation conditions and triage decisions. Methods We conducted a retrospective cohort study in two large referral university hospitals in the Netherlands. We identified all adult cancer patients for whom ICU admission was requested from 2016 to 2019. Via a multivariable logistic regression analysis, we assessed the association between 30-day mortality, and ICU admission consultation conditions and triage decisions. Results Of the 780 cancer patients for whom ICU admission was requested, 332 patients (42.6%) were considered ‘too well to benefit’ from ICU admission, 382 (49%) patients were immediately admitted to the ICU and 66 patients (8.4%) were considered ‘too sick to benefit’ according to the consulting intensivist(s). The 30-day mortality in these subgroups was 30.1%, 36.9% and 81.8%, respectively. In the patient group considered ‘too well to benefit’, 258 patients were never admitted to the ICU and 74 patients (9.5% of the overall study population, 22.3% of the patients ‘too well to benefit’) were admitted to the ICU after a second ICU admission request (delayed ICU admission). Thirty-day mortality in these groups was 25.6% and 45.9%. After adjustment for confounders, ICU consultations during off-hours (OR 1.61, 95% CI 1.09–2.38, p-value 0.02) and delayed ICU admission (OR 1.83, 95% CI 1.00–3.33, p-value 0.048 compared to “ICU admission”) were independently associated with 30-day mortality. Conclusion The ICU denial rate in our study was high (51%). Sixty percent of the ICU triage decisions in cancer patients were made during off-hours, and 22.3% of the patients initially considered “too well to benefit” from ICU admission were subsequently admitted to the ICU. Both decisions during off-hours and a delayed ICU admission were associated with an increased risk of death at 30 days. Our study suggests that in cancer patients, ICU triage decisions should be discussed during on-hours, and ICU admission policy should be broadened, with a lower admission threshold for critically ill cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00898-2.
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Affiliation(s)
- Esther N van der Zee
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | | | - Marinus Hazenbroek
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jan Bakker
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Pulmonology and Critical Care, New York University, New York, USA.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Nuray Kusadasi
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle L Epker
- Department of Intensive Care, Erasmus MC University Medical Center, Room Ne-403, Doctor molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients. Ann Intensive Care 2021; 11:120. [PMID: 34331626 PMCID: PMC8325749 DOI: 10.1186/s13613-021-00895-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00895-5.
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Costa RT, Zampieri FG, Caruso P, Nassar Júnior AP. Performance status and acute organ dysfunction influence hospital mortality in critically ill patients with cancer and suspected infection: a retrospective cohort analysis. Rev Bras Ter Intensiva 2021; 33:298-303. [PMID: 34231811 PMCID: PMC8275091 DOI: 10.5935/0103-507x.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate how performance status impairment and acute organ dysfunction influence hospital mortality in critically ill patients with cancer who were admitted with suspected sepsis. Methods Data were obtained from a retrospective cohort of patients, admitted to an intensive care unit, with cancer and with a suspected infection who received parenteral antibiotics and underwent the collection of bodily fluid samples. We used logistic regression with hospital mortality as the outcome and the Sequential Organ Failure Assessment score, Eastern Cooperative Oncology Group status, and their interactions as predictors. Results Of 450 patients included, 265 (58.9%) died in the hospital. For patients admitted to the intensive care unit with lower Sequential Organ Failure Assessment (≤ 6), performance status impairment influenced the in-hospital mortality, which was 32% among those with no and minor performance status impairment and 52% among those with moderate and severe performance status impairment, p < 0.01. However, for those with higher Sequential Organ Failure Assessment (> 6), performance status impairment did not influence the in-hospital mortality (73% among those with no and minor impairment and 84% among those with moderate and severe impairment; p = 0.1). Conclusion Performance status impairment seems to influence hospital mortality in critically ill cancer patients with suspected sepsis when they have less severe acute organ dysfunction at the time of intensive care unit admission.
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Affiliation(s)
- Ramon Teixeira Costa
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
| | | | - Pedro Caruso
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
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Awad WB, Nazer L, Elfarr S, Abdullah M, Hawari F. A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock. BMC Cancer 2021; 21:709. [PMID: 34130642 PMCID: PMC8207763 DOI: 10.1186/s12885-021-08452-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Though sepsis is common in patients with cancer, there are limited studies that evaluated sepsis and septic shock in this patient population. The objective of this study was to evaluate the outcomes and to identify predictors of mortality in cancer patients admitted to the intensive care unit (ICU) with septic shock. Methods This was a retrospective study conducted at a medical-surgical oncologic ICU of a comprehensive cancer center. Adult cancer patients admitted with septic shock between January 1, 2008 and December 31, 2019 were enrolled. Septic shock was defined as an ICU admission diagnosis of sepsis that required initiating vasopressors within 24 h of admission. Patient baseline characteristics, ICU length of stay and ICU and hospital mortality were recorded. Univariate analysis and logistic regression were performed to identify predictors associated with ICU and hospital mortality. Results During the study period, 1408 patients met the inclusion criteria. The mean age was 56.8 ± 16.1 (SD) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 23.0 ± 7.91 (SD). Among the enrolled patients, 67.8% had solid tumors while the remaining had hematological malignancies. Neutropenia and thrombocytopenia were reported in 19.3 and 39.5% of the patients, respectively, and mechanical ventilation was required for 42% of the patients. Positive cultures were reported in 836 (59.4%) patients, most commonly blood (33%) and respiratory (26.6%). Upon admission, about half the patients had acute kidney injury, while elevated total bilirubin and lactic acid levels were reported in 13.8 and 65.2% of the patients, respectively. The median ICU length of stay was 4 days (IQR 3–8), and ICU and hospital mortality were reported in 688 (48.9%) and 914 (64.9%) patients, respectively. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significantly associated with both ICU and hospital mortality. Conclusions In a relatively large cohort of patients with solid and hematological malignancies admitted to the ICU with septic shock, hospital mortality was reported in about two-third of the patients. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significant predictors of mortality.
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Affiliation(s)
- Wedad B Awad
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Salam Elfarr
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Maha Abdullah
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Feras Hawari
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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Olaechea Astigarraga PM, Álvarez Lerma F, Beato Zambrano C, Gimeno Costa R, Gordo Vidal F, Durá Navarro R, Ruano Suarez C, Aldabó Pallás T, Garnacho Montero J. Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study. Med Intensiva 2021; 45:332-346. [PMID: 34127405 DOI: 10.1016/j.medine.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/26/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS Subjects admitted during over 24 h and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1%-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; p < .001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted to the ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).
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Affiliation(s)
- P M Olaechea Astigarraga
- Servicio de Medicina Intensiva, Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain.
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - C Beato Zambrano
- Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - R Gimeno Costa
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R Durá Navarro
- Servicio Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C Ruano Suarez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
| | - T Aldabó Pallás
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Garnacho Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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van der Zee EN, Noordhuis LM, Epker JL, van Leeuwen N, Wijnhoven BPL, Benoit DD, Bakker J, Kompanje EJO. Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study. PLoS One 2021; 16:e0252771. [PMID: 34115771 PMCID: PMC8195393 DOI: 10.1371/journal.pone.0252771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Given clinicians' frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission. MATERIALS AND METHODS This was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson's Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients. RESULTS Of the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0-2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21-65.89) was independently associated with 2-year mortality. CONCLUSIONS In our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.
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Affiliation(s)
- Esther N. van der Zee
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Lianne M. Noordhuis
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jelle L. Epker
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas P. L. Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jan Bakker
- Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center, New York, NY, United States of America
- Department of Pulmonology and Critical Care Columbia University Irvine Medical Center, New York, NY, United States of America
- Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erwin J. O. Kompanje
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
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Sepsis and Septic Shock in Patients With Malignancies: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. Crit Care Med 2021; 48:822-829. [PMID: 32317596 DOI: 10.1097/ccm.0000000000004322] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. DATA SOURCE Seven European ICUs. STUDY SELECTION A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality. DATA EXTRACTION Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). DATA SYNTHESIS Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not. CONCLUSIONS Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.
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Gudiol C, Albasanz-Puig A, Cuervo G, Carratalà J. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front Med (Lausanne) 2021; 8:636547. [PMID: 33869250 PMCID: PMC8044357 DOI: 10.3389/fmed.2021.636547] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
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Affiliation(s)
- Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Adaia Albasanz-Puig
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
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Kim YJ, Kim MJ, Kim YJ, Kim WY. Short and Long-Term Mortality Trends for Cancer Patients with Septic Shock Stratified by Cancer Type from 2009 to 2017: A Population-Based Cohort Study. Cancers (Basel) 2021; 13:cancers13040657. [PMID: 33562125 PMCID: PMC7931033 DOI: 10.3390/cancers13040657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary This study aimed to assess short and long-term mortality trends in cancer patients with septic shock from 2009 to 2017. Among 43,466 adult cancer patients with septic shock (90% solid and 10% hematologic cancer cases) who presented at an emergency department (ED) in Korea between 2009 and 2017, the 30-day and 1-year mortality rates were 52.1% and 81.3%, respectively. The overall 30-day mortality decreased by 4.8% annually from 2013 to 2017, whereas the 1-year mortality only showed a 1.9% annual decrease over this same period. Pancreatic cancer cases showed the most significant improvement in the 30-day mortality since 2014, and lung and stomach cancer showed a sustained decrease in this metric during the whole study period. The outcomes of cancer patients with septic shock have improved in recent years across most cancer types. Physicians should have expectations of improved prognoses in cancer patients admitted to the ED with septic shock. Abstract There have been recent advances in both cancer and sepsis management. This study aimed to assess short and long-term mortality trends in cancer patients with septic shock from 2009 to 2017 by cancer type. This nationwide population-based cohort study using data from the National Health Insurance Service of Korea included adult cancer patients who presented to an emergency department (ED) with septic shock from 2009 to 2017. Among 43,466 adult cancer patients with septic shock (90% solid and 10% hematologic cancer cases), the 30-day and 1-year mortality rates were 52.1% and 81.3%, respectively. The overall 30-day mortality showed a marked decrease of 4.8% annually from 2013 to 2017, but the annual decrease in the 1-year mortality over the same period was only 1.9%. Pancreatic cancer cases showed the most significant improvement in 30-day mortality between 2014 and 2019 (11.0% decrease/year). Lung and stomach cancers showed a sustained decrease in 30-day mortality during the whole study period (1.7% and 2.0% decrease/year, respectively). The outcomes of cancer patients with septic shock have improved in recent years across most cancer types. Physicians should have expectations of an improved prognosis in cancer patients admitted to the ED with septic shock.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul 05505, Korea; (M.-J.K.); (Y.-J.K.)
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul 05505, Korea; (M.-J.K.); (Y.-J.K.)
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
- Correspondence: ; Tel.: +82-2-3010-3350
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Factors associated with survival of patients with solid Cancer alive after intensive care unit discharge between 2005 and 2013. BMC Cancer 2021; 21:9. [PMID: 33402107 PMCID: PMC7786972 DOI: 10.1186/s12885-020-07706-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022] Open
Abstract
Background At intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge. Our objective was to assess the factors associated with 3- and 6-month survival of ICU cancer survivors. Methods Based on the French OutcomeRea™ database, we included solid cancer patients discharged alive, between December 2005 and November 2013, from the medical ICU of the university hospital in Grenoble, France. Patient characteristics and outcome at 3 and 6 months following ICU discharge were extracted from available database. Results Of the 361 cancer patients with unscheduled admissions, 253 (70%) were discharged alive from ICU. The main primary cancer sites were digestive (31%) and thoracic (26%). The 3- and 6-month mortality rates were 33 and 41%, respectively. Factors independently associated with 6-month mortality included ECOG performance status (ECOG-PS) of 3–4 (OR,3.74; 95%CI: 1.67–8.37), metastatic disease (OR,2.56; 95%CI: 1.34–4.90), admission for cancer progression (OR,2.31; 95%CI: 1.14–4.68), SAPS II of 45 to 58 (OR,4.19; 95%CI: 1.76–9.97), and treatment limitation decision at ICU admission (OR,4.00; 95%CI: 1.64–9.77). Interestingly, previous cancer chemotherapy prior to ICU admission was independently associated with lower 3-month mortality (OR, 0.38; 95%CI: 0.19–0.75). Among patients with an ECOG-PS 0–1 at admission, 70% (n = 66) and 61% (n = 57) displayed an ECOG-PS 0–2 at 3- and 6-months, respectively. At 3 months, 74 (55%) patients received anticancer treatment, 13 (8%) were given exclusive palliative care. Conclusions Factors associated with 6-month mortality are almost the same as those known to be associated with ICU mortality. We highlight that most patients recovered an ECOG-PS of 0–2 at 3 and 6 months, in particular those with a good ECOG-PS at ICU admission and could benefit from an anticancer treatment following ICU discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07706-3.
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Gao S, Wang Y, Yang L, Wang Z, Huang W. Characteristics and clinical subtypes of cancer patients in the intensive care unit: a retrospective observational study for two large databases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:13. [PMID: 33553306 PMCID: PMC7859733 DOI: 10.21037/atm-20-4634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Previous studies have reported very different mortality rates among cancer patients in the intensive care unit (ICU), implying different clinical subtypes. We aimed to reveal the clinical subtypes and demonstrate the importance of segregating the patients in clinical research, and to report the ICD-level mortality of cancer patients in the ICU. Methods Two ICU databases (MIMIC-III and eICU) were utilized to identify cancer patients. Mortality based on ICD-level diagnoses were calculated, and K-means clustering was used to identify different clinical subtypes in the MIMIC database. Clinical characteristics and outcomes were compared among subtypes, and the calibration of SAPS II and APACHE IV among different subtypes was evaluated. Results In total, 6,505 (13.8%) cancer patients of the MIMIC database and 7,351 (4.9%) ones in eICU database, were enrolled in the study. Metastasis involving pleura, metastasis involving the liver, and acute myeloid leukemia were in the top 5 diagnoses with the highest mortality in both databases. Clinical subtypes identified by K-means clustering were closely associated with admission type (elective or emergency) and clinical service provider (surgical or medical). In a four-cluster pattern, nearly all patients in the first cluster were elective admissions (99.1%), whereas in the rest of the clusters, most were emergency admissions (93.7%). Most surgical patients were in the 1+2 clusters (92.0%) and most medical patients were in the 3+4 clusters (93.5%). Most characteristics and outcomes as well as the calibration of SAPS II and APACHE IV scoring systems were significantly different among clinical subtypes. Conclusions Different clinical subtypes can be well identified by admission type and clinical service provider among ICU patients with cancer. Caution should be exercised when considering these patients as a whole population both in clinical practice and research. Moreover, APACHE IV has better calibration than SAPS II for cancer patients at low risk of mortality in the ICU.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Yang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Siddiqui SS, Prabu NR, Chaudhari HK, Narkhede AM, Sarode SV, Dhundi U, Divatia JV, Kulkarni AP. Epidemiology, Clinical Characteristics, and Prognostic Factors in Critically Ill Patients with Hematolymphoid Malignancy. Indian J Crit Care Med 2021; 25:56-61. [PMID: 33603303 PMCID: PMC7874294 DOI: 10.5005/jp-journals-10071-23469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Despite advances in the field of oncology and intensive care, the outcomes of hematolymphoid malignancy (HLM) patients admitted to ICU are poor. This study was carried out to look at the demographic data, clinical features, and predictors of hospital mortality in these patients. Materials and methods We prospectively studied 101 adult critically ill patients with HLM admitted to the 14-bedded mixed medical surgical ICU of a tertiary care cancer center. Out of 101 patients, end-of-life care decisions were taken in 7 patients, who were excluded from the outcome analysis. Predictors of in-hospital mortality were evaluated using univariate and multivariate analysis. Results The ICU and in-hospital mortality recorded in our study were 48.9 and 54.3%, respectively. Neutropenia at ICU admission, Simplified Acute Physiology Score III (SAPS III) score, and mechanical ventilation (MV) within 24 hours of ICU admission were associated with in-hospital mortality on univariate analysis. On multivariate logistic regression analysis, neutropenia at ICU admission (OR 4.621; 95% CI, 1.2–17.357) and MV within 24 hours of ICU admission (OR 2.728; 95% CI, 1.077–6.912) were independent predictors of in-hospital mortality. Conclusion The HLM patients needing critical care have high acuity of illness, and acute respiratory failure is the commonest reason for ICU admission in these patients. In our study, the ICU survival was more than 50% and more than 45% patients were discharged alive from the hospital. We found a need for MV within 24 hours of ICU admission and presence of neutropenia at ICU admission to be independent predictors of hospital mortality in our study. How to cite this article Siddiqui SS, Prabu NR, Chaudhari HK, Narkhede AM, Sarode SV, Dhundi U, et al. Epidemiology, Clinical Characteristics, and Prognostic Factors in Critically Ill Patients with Hematolymphoid Malignancy. Indian J Crit Care Med 2021;25(1):56–61.
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Affiliation(s)
- Suhail S Siddiqui
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Natesh R Prabu
- Department of Critical Care Medicine, St John's Medical College, Bengaluru, Karnataka, India
| | | | - Amit M Narkhede
- Department of Critical Care, Jupiter Hospital, Thane, Maharashtra, India
| | - Satish V Sarode
- Vishwaraj Super Speciality Hospital, Pune, Maharashtra, India
| | - Ujwal Dhundi
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Nassar Junior AP, Trevisani MDS, Bettim BB, Zampieri FG, Carvalho JA, Silva A, de Freitas FGR, Pinto JEDSS, Romano E, Ramos SR, Faria GBA, Silva UVAE, Santos RC, Tommasi EDO, de Moraes APP, da Cruz BA, Bozza FA, Caruso P, Salluh JIF, Soares M. Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country. PLoS One 2020; 15:e0238124. [PMID: 32822433 PMCID: PMC7442258 DOI: 10.1371/journal.pone.0238124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). METHODS This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. RESULTS Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). CONCLUSIONS Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.
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Affiliation(s)
| | | | | | - Fernando Godinho Zampieri
- ID’Or, Research and Education Institute, São Paulo, Brazil
- Research Institute, HCor—Hospital do Coração, São Paulo, Brazil
- Center for Epidemiological and Clinical Research, University of Odense, Odense, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | - Fernando Augusto Bozza
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Pedro Caruso
- A.C. Camargo Cancer Center, São Paulo, Brazil
- Discipline of Pulmonology, Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | - Marcio Soares
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
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van der Zee EN, Epker JL, Bakker J, Benoit DD, Kompanje EJO. Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit. J Intensive Care Med 2020; 36:42-50. [PMID: 32787659 PMCID: PMC7705645 DOI: 10.1177/0885066620948453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Treatment limitation decisions (TLDs) on the ICU can be challenging, especially in patients with a malignancy. Up-to-date literature regarding TLDs in critically ill patients with a malignancy admitted to the ICU is scarce. The aim was to compare the incidence of written TLDs between patients with an active malignancy, patients with a malignancy in their medical history (complete remission, CR) and patients without a malignancy admitted unplanned to the ICU. Methods: We conducted a retrospective cohort study in a large university hospital in the Netherlands. We identified all unplanned admissions to the ICU in 2017 and categorized the patients in 3 groups: patients with an active malignancy (study population), with CR and without a malignancy. A TLD was defined as a written instruction not to perform life-saving treatments, such as CPR in case of cardiac arrest. A multivariate binary logistic regression analysis was used to identify whether having a malignancy was associated with TLDs. Results: Of the 1046 unplanned admissions, 125 patients (12%) had an active malignancy and 76 (7.3%) patients had CR. The incidence of written TLDs in these subgroups were 37 (29.6%) and 20 (26.3%). Age (OR 1.03; 95% CI 1.01 -1.04), SOFA score at ICU admission (OR 1.11; 95% CI 1.05 -1.18) and having an active malignancy (OR 1.75; 95% CI 1.04-2.96) compared to no malignancy were independently associated with written TLDs. SOFA scores on the day of the TLD were not significantly different in patients with and without a malignancy. Conclusions: This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay. Patients with CR were not at risk of more written TLDs. Whether this higher incidence of TLDs in patients with a malignancy is justified, is at least questionable and should be evaluated in future research.
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Affiliation(s)
- Esther N van der Zee
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jelle L Epker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jan Bakker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands.,Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center, New York, NY, USA.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, NY, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dominique D Benoit
- Department of Intensive Care, 60200Ghent University Hospital, Ghent, Belgium
| | - Erwin J O Kompanje
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
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Zampieri FG, Romano TG, Salluh JIF, Taniguchi LU, Mendes PV, Nassar AP, Costa R, Viana WN, Maia MO, Lima MFA, Cappi SB, Carvalho AGR, De Marco FVC, Santino MS, Perecmanis E, Miranda FG, Ramos GV, Silva AR, Hoff PM, Bozza FA, Soares M. Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study. Intensive Care Med 2020; 47:170-179. [PMID: 32770267 DOI: 10.1007/s00134-020-06184-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. METHODS We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. RESULTS 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. CONCLUSION Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.
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Affiliation(s)
- Fernando G Zampieri
- Department of Critical Care, D'Or Institute for Research and Education, 30. Botafogo, Rio de Janeiro, Brazil
- Research Institute, HCor, São Paulo, Brazil
- Center of Epidemiological and Clinical Research, Southern Denmark University, Odense, Denmark
| | - Thiago G Romano
- Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil
- Nephrology Department, ABC Medical School, Santo André, Brazil
- Oncological Intensive Care Unit, Unidade Itaim, Hospital São Luiz, São Paulo, Brazil
| | - Jorge I F Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Leandro U Taniguchi
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
- Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil
| | - Pedro V Mendes
- Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil
- Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil
- Oncological Intensive Care Unit, Unidade Itaim, Hospital São Luiz, São Paulo, Brazil
| | - Antonio P Nassar
- Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Roberto Costa
- Intensive Care Unit, Hospital Quinta D'Or, Rio de Janeiro, Brazil
| | - William N Viana
- Intensive Care Unit, Hospital Copa D'Or, Rio de Janeiro, Brazil
| | - Marcelo O Maia
- Intensive Care Unit, Hospital Santa Luzia Rede D'Or São Luiz, Brasília, Brazil
- Intensive Care Unit, Hospital DF Star Rede D'Or São Luiz, Brasília, Brazil
| | - Mariza F A Lima
- Intensive Care Unit, Hospital Esperança Recife, Recife, Brazil
| | - Sylas B Cappi
- Intensive Care Unit, Unidade Brasil, Hospital São Luiz, Santo André, Brazil
| | | | | | | | - Eric Perecmanis
- Intensive Care Unit, Hospital Caxias D'Or, Duque de Caxias, Brazil
| | - Fabio G Miranda
- Intensive Care Unit, Hospital Copa Star, Rio de Janeiro, Brazil
| | - Grazielle V Ramos
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Aline R Silva
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Paulo M Hoff
- Department of Critical Care, D'Or Institute for Research and Education, 30. Botafogo, Rio de Janeiro, Brazil
- Oncologia D'Or, São Paulo, Brazil
| | - Fernando A Bozza
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
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Freitas ICLD, Assis DMD, Amendola CP, Russo DDS, Moraes APPD, Caruso P, Nassar Júnior AP. Characteristics and short-term outcomes of patients with esophageal cancer with unplanned intensive care unit admissions: a retrospective cohort study. Rev Bras Ter Intensiva 2020; 32:229-234. [PMID: 32667448 PMCID: PMC7405734 DOI: 10.5935/0103-507x.20200041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To depict the clinical presentation and outcomes of a cohort of critically ill patients with esophageal cancer. METHODS We carried out a multicenter retrospective study that included patients with esophageal cancer admitted to intensive care units with acute illness between September 2009 and December 2017. We collected the demographic and clinical characteristics of all included patients, as well as organ-support measures and hospital outcomes. We performed logistic regression analysis to identify independent factors associated with in-hospital mortality. RESULTS Of 226 patients included in the study, 131 (58.0%) patients died before hospital discharge. Squamous cell carcinoma was more frequent than adenocarcinoma, and 124 (54.9%) patients had metastatic cancer. The main reasons for admission were sepsis/septic shock and acute respiratory failure. Mechanical ventilation (OR = 6.18; 95%CI 2.86 - 13.35) and metastatic disease (OR = 7.10; 95%CI 3.35 - 15.05) were independently associated with in-hospital mortality. CONCLUSION In this cohort of patients with esophageal cancer admitted to intensive care units with acute illness, the in-hospital mortality rate was very high. The requirement for invasive mechanical ventilation and metastatic disease were independent prognostic factors and should be considered in discussions about the short-term outcomes of these patients.
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Affiliation(s)
| | | | | | | | | | - Pedro Caruso
- A. C. Camargo Cancer Center, São Paulo, SP, Brasil
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Nassar Junior AP, Trevisani MDS, Bettim BB, Caruso P. Long-term mortality in very old patients with cancer admitted to intensive care unit: A retrospective cohort study. J Geriatr Oncol 2020; 12:106-111. [PMID: 32565146 DOI: 10.1016/j.jgo.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/23/2020] [Accepted: 06/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Long-term outcomes of older patients referred to intensive care unit (ICU) are of paramount importance for care planning and counseling of patients and relatives. METHODS We performed a retrospective study with patients aged ≥80 years admitted to ICU from 2011 to 2017 in a cancer center. We performed two Cox proportional hazard regressions. In the first, we tested whether type of cancer (solid locoregional, solid metastatic or hematologic), Eastern Cooperative Oncology Group Performance Status (ECOG PS), and comorbidities [Charlson Comorbidity Index - CCI]) were associated with one-year mortality in all patients. In the second, we assessed whether delirium, use of vasopressors, mechanical ventilation, renal replacement therapy, and forgoing life-sustaining therapies were associated with one-year mortality in survivors to hospital discharge. RESULTS Of 763 patients included, 482 (62.3%) patients died at one year. Metastatic cancer was significantly associated with one-year mortality (HR = 1.97; CI 95%, 1.16-3.36), but hematologic cancer, CCI and ECOG PS were not. Among patients who survived to hospital discharge, delirium, use of vasopressors, mechanical ventilation, renal replacement therapy and decisions to forgo life-sustaining therapies in ICU were not associated with one-year mortality. CONCLUSIONS Metastatic disease at ICU admission was associated with one-year mortality in patients aged ≥80 years. Delirium, use of vasopressors, mechanical ventilation and renal replacement therapy and decisions to forgo life-sustaining therapies in ICU were not associated with one-year mortality among the patients discharged from hospital.
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Affiliation(s)
| | | | | | - Pedro Caruso
- Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil; Discipline of Pulmonology, Heart Institute (InCor), University of São Paulo, Brazil
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Chen ZQ, Yu XS, Mao LJ, Zheng R, Xue LL, Shu J, Luo ZW, Pan JY. Prognostic value of neutrophil-lymphocyte ratio in critically ill patients with cancer: a propensity score matching study. Clin Transl Oncol 2020; 23:139-147. [PMID: 32472452 DOI: 10.1007/s12094-020-02405-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) has shown a good prognostic value in many different type of malignancies. The purpose of this study was to investigate the relationship between NLR and the outcome of critically ill patients with cancer. METHODS We performed a single-institution, retrospective study of 1317 adult critically ill patients with cancer and determined the optimal cut-off for NLR by X-tile software. Propensity score matching (PSM) and inverse probabilities of treatment weighting (IPTW) were performed to control confounders. Cox proportional hazards model was used to evaluate the relationship between NLR and 28-day, 6-month and 1-year all-cause mortality. Kaplan-Meier method, subgroup analysis, and receiver operating characteristics (ROC) analysis were applied to assess the prognostic value of NLR. RESULTS The cut-off value for NLR was 17.6. Cox proportional hazards model demonstrated that high NLR (> 17.6) was independently associated with 28-day, 6-month and 1-year all-cause mortality with hazard ratio (HR) of 1.58 (1.29, 1.94), 1.51 (1.28, 1.77) and 1.45 (1.25, 1.69), respectively. The results were consistent with survival analyses (p < 0.001, log-rank test). The ROC analyses showed that the discrimination abilities of NLR were better than other blood-based biomarkers. CONCLUSION NLR is a promising prognostic indicator of survival in unselected critical ill patients with cancer.
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Affiliation(s)
- Z-Q Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - X-S Yu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - L-J Mao
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - R Zheng
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - L-L Xue
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - J Shu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Z-W Luo
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - J-Y Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China.
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Acute kidney injury in critically ill cancer patients is associated with mortality: A retrospective analysis. PLoS One 2020; 15:e0232370. [PMID: 32437362 PMCID: PMC7241809 DOI: 10.1371/journal.pone.0232370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/13/2020] [Indexed: 01/31/2023] Open
Abstract
Background In critically ill patients, acute kidney injury (AKI) is common and associated with short- and long-term complications. Our objectives were to describe the epidemiology and impact of AKI in cancer patients admitted to the Intensive Care Unit (ICU). Methods We identified all patients with a haematological malignancy (HM) or solid tumour (ST) who had an emergency admission to the ICU in a tertiary care centre between January 2004 and July 2012. AKI was defined according to the KDIGO criteria. Results 429 patients were included of whom 259 (60%) had AKI. Among HM patients, 73 (78%) had AKI (70% AKI on admission to ICU; 7% during ICU stay); among ST patients, 186 (56%) had AKI (45% on admission to ICU, 11% during ICU stay). ICU and 28-day mortality rates were 33% and 48%, respectively in HM patients, and 22% and 31%, respectively in ST patients. Multivariable analysis showed that AKI was an independent risk factor for both ICU and 28-day mortality. New AKI after 24 hours in ICU was associated with higher mortality than AKI on admission. Conclusions AKI is common in critically ill cancer patients and independently associated with ICU and 28-day mortality.
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Almansour IM, Hasanien AA, Saleh ZT. Mortality Rate, Demographics, and Clinical Attributes of Patients Dying in the Intensive Care Unit of a Comprehensive Cancer Center in Jordan: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:1011-1024. [PMID: 32390505 DOI: 10.1177/0030222820923929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Very little is known about the provision of or the need for palliative care in the Middle East, including Jordan. This study investigated the mortality rate, demographics, and clinical attributes of patients with cancer who had died in the intensive care unit (ICU) of a national cancer center over a 3-year period in Jordan. We reviewed the records of 661 patients who had died and found that the majority of the people were terminally ill at the time of admission (had metastatic cancer, multisystem organ dysfunction, and seriously ill). This approach differs from the usual practice worldwide in which it is uncommon to admit patients with cancer to the ICU at the end of life. Improving end-of-life care in the ICUs in Jordan requires further exploration of the cultural context in which end-of-life care practice occurs in Jordan and developing a palliative care approach that fit with the Islamic and Arabic culture.
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Affiliation(s)
- Issa M Almansour
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Amer A Hasanien
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Zyad T Saleh
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
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Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study. Med Intensiva 2020. [PMID: 32307264 DOI: 10.1016/j.medin.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS Subjects admitted during over 24hours and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; P<.001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted in ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).
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