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Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses

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Abstract

Objectives

To evaluate the outcomes of patients with head and neck cancer and severe acute illnesses, and to identify characteristics associated with hospital mortality.

Design

Cohort study.

Setting

Ten-bed medical–surgical oncologic intensive care unit (ICU).

Patients

Consecutive patients admitted to the ICU over a 68-month period.

Interventions

None.

Measurements and results

Demographic, clinical and cancer-related data were collected. Multivariate logistic regression analysis was performed to identify predictive factors of hospital mortality. One hundred and twenty-one patients aged 63.3 ± 14.7 years were enrolled in the study. The main sites of primary tumor were oral cavity (30%), larynx (25%), pharynx (14%) and thyroid (9%). The main reasons for ICU admission were sepsis (37%) and acute respiratory failure (20%). The mean SAPS II score was 49.6 ± 17.8 points, and during ICU stay 100 (83%) patients received mechanical ventilation, 70 (58%), vasopressors, and 12 (10%), dialysis. The ICU, hospital and 6-month mortality rates were 39%, 56% and 72%, respectively. A performance status ≥ 2 [odds ratio (OR) = 5.17 (95% confidence interval, CI = 1.84–14.53)], advanced cancer (TNM stage IV) [OR = 3.80 (95% CI = 1.28–11.28)], and the number of organ failures [OR=2.87 (95% CI=1.83–4.50)] were associated with increased mortality in multivariate analysis.

Conclusions

In conjunction with clinical judgment and taking into consideration the patient's preferences and values, the knowledge of these outcome predictors may be useful in helping physicians to identify patients who might benefit from the intensive care and to improve discussions on patients' prognosis.

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Authors and Affiliations

  1. Intensive Care Unit, Centro de Tratamento Intensivo, Instituto Nacional de Câncer–INCA, Praça Cruz Vermelha, 23 - 10° Andar, 20230-130, Rio de Janeiro, Brazil

    Márcio Soares, Jorge I. F. Salluh & Luisa Toscano

  2. Department of Head and Neck Surgery, Instituto Nacional de Câncer, Rio de Janeiro, Brazil

    Fernando L. Dias

Authors
  1. Márcio Soares
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  2. Jorge I. F. Salluh
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  3. Luisa Toscano
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  4. Fernando L. Dias
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Corresponding author

Correspondence to Márcio Soares.

Additional information

This work was performed at the Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.

This study is original and was not previously submitted to another primary scientific journal. Preliminary data were presented as a poster at the 2005 American Head & Neck Society Annual Meeting in Boca Raton, FL, USA, and at the 9th Congress of the World Federation of Intensive and Critical Care Medicine in Buenos Aires, Argentina, 27–31 August 2005.

Financial support: Institutional departmental funds

Conflicts of interest: None

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Soares, M., Salluh, J.I.F., Toscano, L. et al. Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses. Intensive Care Med 33, 2009–2013 (2007). https://doi.org/10.1007/s00134-007-0775-z

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  • DOI: https://doi.org/10.1007/s00134-007-0775-z

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