Elsevier

Journal of Critical Care

Volume 29, Issue 4, August 2014, Pages 618-626
Journal of Critical Care

Monitoring/Outcomes
Prognostic factors in critically ill cancer patients admitted to the intensive care unit

https://doi.org/10.1016/j.jcrc.2014.01.014Get rights and content

Abstract

Objective

The objective of this study is to identify factors predicting intensive care unit (ICU) mortality in cancer patients admitted to a medical ICU.

Patients and methods

We conducted a retrospective study in 162 consecutive cancer patients admitted to the medical ICU of a 1000-bed university hospital between January 2009 and June 2012. Medical history, physical and laboratory findings on admission, and therapeutic interventions during ICU stay were recorded. The study end point was ICU mortality. Logistic regression analysis was performed to identify independent risk factors for ICU mortality.

Results

The study cohort consisted of 104 (64.2%) patients with solid tumors and 58 patients (35.8%) with hematological malignancies. The major causes of ICU admission were sepsis/septic shock (66.7%) and respiratory failure (63.6%), respectively. Overall ICU mortality rate was 55 % (n = 89). The ICU mortality rates were similar in patients with hematological malignancies and solid tumors (57% vs 53.8%; P = .744). Four variables were independent predictors for ICU mortality in cancer patients: the remission status of the underlying cancer on ICU admission (odds ratio [OR], 0.113; 95% confidence interval [CI], 0.027-0.48; P = .003), Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.032-1.215; P = .007), sepsis/septic shock during ICU stay (OR, 8.94; 95% CI, 2.28-35; P = .002), and vasopressor requirement (OR 16.84; 95% CI, 3.98-71.24; P = .0001). Although Acute Physiology and Chronic Health Evaluation II score (OR, 1.30; 95% CI, 1.054-1.61; P = .014), admission through emergency service (OR, 0.005; 95% CI, 0.00-0.69; P = .035), and vasopressor requirement during ICU stay (OR, 140.64; 95% CI, 3.59-5505.5; P = .008) were independent predictors for ICU mortality in patients with hematological malignancies, Sequential Organ Failure Assessment score (OR, 1.83; 95% CI, 1.29-2.6; P = .001), lactate dehydrogenase level on admission (OR, 1.002; 95% CI, 1-1.005; P = .028), sepsis/septic shock during ICU stay (OR, 138.4; 95% CI, 12.54-1528.4; P = .0001), and complete or partial remission of the underlying cancer (OR, 0.026; 95% CI, 0.002-0.3; P = .004) were the independent risk factors in patients with solid tumors.

Conclusion

Intensive care unit mortality rate was 55% in our cancer patients, which suggests that patients with cancer can benefit from ICU admission. We also found that ICU mortality rates of patients with hematological malignancies and solid tumors were similar.

Introduction

The growing number of patients living with cancer leads to a similar increase in the number of patients requiring intensive care. Despite the general opinion that admission of cancer patients to intensive care units (ICUs) is usually futile and costly based on some older studies, ICU survival has been reported to be improved significantly in recent studies [1], [2], [3], [4]. Increased survival expectancy in critically ill cancer patients led conduction of studies that investigate the prognostic factors that predict ICU outcome and guide ICU admission and management strategies [1], [2], [3], [4], [5], [6], [7], [8]. We, therefore, analyzed our data retrospectively to determine the characteristics and outcomes of cancer patients admitted to our medical ICU and to identify the risk factors associated with ICU mortality.

Section snippets

Study design

This study is a retrospective, observational study conducted in the 9-bed medical ICU of the Gazi University Hospital, a 1000-bed university hospital in Ankara, Turkey. Every adult patient (≥ 18 years old) with histologically proven cancer who required ICU admission was evaluated between January 1, 2009, and June 30, 2012. When ICU admission is considered in a cancer patient in our center, life expectancy should be longer than 3 months, and/or further treatment options to treat the underlying

Results in the whole study cohort

There were 1130 admissions during the study period, among whom 162 (14.3%) were cancer patients who met the eligibility criteria of the study. Median age was 61 (48-71.3) years, and most patients were male (58.6%). The most common causes of ICU admission were sepsis/septic shock (66.7%) and respiratory failure (63.6%). The most common comorbidities of the patients were cardiovascular diseases, diabetes, and hypertension. Most patients were admitted to our medical ICU from emergency service. Two

Discussion

There is growing number of ICU admissions of cancer patients in parallel to the increase in patients living with cancer. Patients with cancer are more severely ill than the patients without cancer, resulting in higher ICU and hospital mortality rates. Similarly, our ICU mortality rate in cancer patients was 55% and higher than the overall mortality of 32%. Previous studies have reported ICU mortality between 10% and 70% in cancer patients. This large interstudy variation in the mortality rates

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