Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study.

Abstract

OBJECTIVE:

To evaluate the characteristics and outcomes of patients with cancer admitted to several intensive care units. Knowledge on patients with cancer requiring intensive care is mostly restricted to single-center studies.

DESIGN:

: Prospective, multicenter, cohort study.

SETTING:

Intensive care units from 28 hospitals in Brazil.

PATIENTS:

A total of 717 consecutive patients included over a 2-mo period.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 667 (93%) patients with solid tumors and 50 (7%) patients had hematologic malignancies. The main reasons for intensive care unit admission were postoperative care (57%), sepsis (15%), and respiratory failure (10%). Overall hospital mortality rate was 30% and was higher in patients admitted because of medical complications (58%) than in emergency (37%) and scheduled (11%) surgical patients (p < .001). Adjusting for covariates other than the type of admission, the number of hospital days before intensive care unit admission (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.37), higher Sequential Organ Failure Assessment scores (OR, 1.25; 95% CI, 1.17-1.34), poor performance status (OR, 3.40; 95% CI, 2.19 -5.26), the need for mechanical ventilation (OR, 2.42; 95% CI, 1.51-3.87), and active underlying malignancy in recurrence or progression (OR, 2.42; 95% CI, 1.51-3.87) were associated with increased hospital mortality in multivariate analysis.

CONCLUSIONS:

This large multicenter study reports encouraging survival rates for patients with cancer requiring intensive care. In these patients, mortality was mostly dependent on the severity of organ failures, performance status, and need for mechanical ventilation rather than cancer-related characteristics, such as the type of malignancy or the presence of neutropenia.

• Authors: Márcio Soares, Pedro Caruso, Eliézer Silva, José M M Teles, Suzana M A Lobo, Gilberto Friedman, Felipe Dal Pizzol, Patricia V C Mello, Fernando A Bozza, Ulisses V A Silva, André P Torelly, Marcos F Knibel, Ederlon Rezende, José J Netto, Claudio Piras, Aline Castro, Bruno S Ferreira, Alvaro Réa-Neto, Patrícia B Olmedo, Jorge I F Salluh, Brazilian Research in Intensive Care Network (BRICNet)
• Journal: Critical care medicine (Crit Care Med) Vol. 38 Issue 1 Pg. 9-15 (Jan 2010) ISSN: 1530-0293 [Electronic] United States
• PMID: 19829101 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Analysis of Variance
• Brazil
• Cohort Studies
• Confidence Intervals
• Critical Care (statistics & numerical data)
• Female
• Follow-Up Studies
• Hematologic Neoplasms (mortality, pathology, therapy)
• Hospital Mortality (trends)
• Humans
• Intensive Care Units (statistics & numerical data)
• Length of Stay
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasms (mortality, pathology, therapy)
• Odds Ratio
• Outcome Assessment, Health Care
• Patient Admission (statistics & numerical data)
• Probability
• Prospective Studies
• Survival Analysis
• Treatment Outcome
• Young Adult